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Srinivasaraghavan N, Das N, Balakrishnan K, Rajaram S. Effect of Whey Protein Supplementation on Perioperative Outcomes in Patients with Cancer-A Systematic Review and Meta-Analysis (PROSPERO 2020: CRD42020188666). Nutr Cancer 2021; 74:2351-2364. [PMID: 34961401 DOI: 10.1080/01635581.2021.2020302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Whey protein has several biochemical characteristics which make it an ideal nutritional supplement in cancer. This meta-analysis aims to evaluate the effects of whey on perioperative outcomes in cancer. A systematic review was conducted as per the Preferred Reporting of Systematic Reviews and Meta-analysis (PRISMA) guidelines. The primary outcome was postoperative complications. Secondary outcomes included 6-minute walk test, length of stay (LOS), and thirty-day readmission. Of the ten trials, six supplemented whey to meet protein requirements of around 1.2 mg/kg/day, and four supplemented whey variably. A synthesis of ten trials with 643 patients showed significantly decreased postoperative complications in the whey supplemented (22%) group as compared to the control (32%) (OR 0.61, 95% CI 0.41-0.90; P = 0.01). Analysis of six trials showed that patients supplemented with whey had greater functional walking capacity before surgery (MD 23.76 meters, 95% CI 4.05-43.47; participants = 377; P = 0.02) and after 4 weeks of surgery (MD 45.76, 95% CI 14.19-77.33; participants = 366; P = 0.004). Thirty-day readmissions and LOS showed no differences. Risk of bias varied between the trials and evidence was moderate to low. Whey protein supplementation improved the perioperative functional capacity and significantly reduced postoperative complications in patients with cancer.
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Affiliation(s)
| | - Nairita Das
- Department of Anesthesiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Kalpana Balakrishnan
- Department of Anesthesiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Swaminathan Rajaram
- Department of Biostatistics and Cancer Registry, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth 2021; 128:244-257. [PMID: 34922735 DOI: 10.1016/j.bja.2021.11.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The certainty that prehabilitation improves postoperative outcomes is not clear. The objective of this umbrella review (i.e. systematic review of systematic reviews) was to synthesise and evaluate evidence for prehabilitation in improving health, experience, or cost outcomes. METHODS We performed an umbrella review of prehabilitation systematic reviews. MEDLINE, Embase, Cochrane, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Joanna Briggs Institute's database, and Web of Science were searched (inception to October 20, 2020). We included all systematic reviews of elective, adult patients undergoing surgery and exposed to a prehabilitation intervention, where health, experience, or cost outcomes were reported. Evidence certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation. Primary syntheses of any prehabilitation were stratified by surgery type. RESULTS From 1412 titles, 55 systematic reviews were included. For patients with cancer undergoing surgery who participate in any prehabilitation, moderate certainty evidence supports improvements in functional recovery. Low to very low certainty evidence supports reductions in complications (mixed, cardiovascular, and cancer surgery), non-home discharge (orthopaedic surgery), and length of stay (mixed, cardiovascular, and cancer surgery). There was low to very low certainty evidence that exercise prehabilitation reduces the risk of complications, non-home discharge, and length of stay. There was low to very low certainty evidence that nutritional prehabilitation reduces risk of complications, mortality, and length of stay. CONCLUSIONS Low certainty evidence suggests that prehabilitation may improve postoperative outcomes. Future low risk of bias, randomised trials, synthesised using recommended standards, are required to inform practice. Optimal patient selection, intervention design, and intervention duration must also be determined.
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Pang NQ, He SS, Foo JQX, Koh NHY, Yuen TW, Liew MN, Ramya JP, Loy Y, Bonney GK, Cheong WK, Iyer SG, Tan KK, Lim WC, Kow AWC. Multimodal prehabilitation before major abdominal surgery: A retrospective study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:892-902. [PMID: 34985101 DOI: 10.47102/annals-acadmedsg.2021264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme. METHODS Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation. RESULTS There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay (P=0.150) or major complications (P=0.690) were noted. Patients in the prehabilitation group were observed to ambulate a longer distance and participate more actively with their physiotherapists from postoperative day 1 until 4. In the subgroup of patients with cancer, more patients had undergone neoadjuvant therapy in the prehabilitation group compared to the control group (21.7% versus 12.6%, P=0.009). Prehabilitation patients were more likely to proceed to adjuvant chemotherapy (prehabilitation 87.2% vs control 65.6%, P<0.001) if it had been recommended. CONCLUSION The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.
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Affiliation(s)
- Ning Qi Pang
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore
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Metabolic syndrome; associations with adverse outcome after colorectal surgery. A systematic review and meta-analysis. Ann Med Surg (Lond) 2021; 71:102997. [PMID: 34840752 PMCID: PMC8606877 DOI: 10.1016/j.amsu.2021.102997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Increasing evidence shows that patients with Metabolic Syndrome (MetS) are at risk for adverse outcome after abdominal surgery. The aim of this study was to investigate the impact of MetS and preoperative hyperglycemia, as an individual component of MetS, on adverse outcome after colorectal surgery. Methods A literature review was systematically performed according to the PRISMA guidelines. Inclusion criteria were observational studies that evaluated the relationship between MetS or preoperative hyperglycemia and outcomes after colorectal surgery (i.e. any complication, severe complication defined as Clavien-Dindo grade ≥ III, anastomotic leakage, surgical site infection, mortality and length of stay). Results Six studies (246.383 patients) evaluated MetS and eight studies (9.534 patients) reported on hyperglycemia. Incidence rates of MetS varied widely from 7% to 68% across studies. Meta-analysis showed that patients with MetS are more likely to develop severe complications than those without MetS (RR 1.62, 95% CI 1.01–2.59). Moreover, a non-significant trend toward increased risks for any complication (RR 1.35, 95% CI 0.91–2.00), anastomotic leakage (RR 1.67, 95% CI 0.47–5.93) and mortality (RR 1.19, 95% CI 1.00–1.43) was found. Furthermore, preoperative hyperglycemia was associated with an increased risk of surgical site infection (RR 1.35, 95% CI 1.01–1.81). Conclusion MetS seem to have a negative impact on adverse outcome after colorectal surgery. As a result of few studies meeting inclusion criteria and substantial heterogeneity, evidence is not conclusive. Future prospective observational studies should improve the amount and quality in order to verify current results. The prevalence of metabolic syndrome (MetS) in colorectal surgery patients is 7–68%. MetS increases the risk of severe complications after colorectal surgery. Preoperative hyperglycemia, as an individual component of MetS, is associated with surgical site infection. Identification of MetS could be valuable in preoperative risk stratification.
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Key Words
- AHA/NHLBI, American Heart Association/National heart Lung and Blood Institute Scientific Statement
- AMSTAR, A MeaSurement Tool to Assess systematic Reviews
- BG, Blood glucose
- BMI, Body Mass Index
- CAL, Colorectal anastomotic leakage
- CI, Confidence interval
- CRC, Colorectal cancer
- Colorectal surgery
- ERAS, Enhanced Recovery After Surgery
- FPG, Fasting Plasma Glucose
- HbA1c, Hemglobin A1c
- Hyperglycemia
- IDF, International Diabetes Federation
- LoS, Length of stay
- MetS, Metabolic Syndrome
- Metabolic syndrome
- NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III
- NHLBI, National Heart, Lung, and Blood Institute
- NOS, Newcastle-Ottawa Scale
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- Postoperative outcome
- Preoperative care
- RR, Risk Ratio
- SSI, Surgical site infection
- WHO, World Health Organization
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Santa Mina D, Adams SC, Brahmbhatt P, Ferreira V, St-Pierre J, Scheede-Bergdahl C. Introduction to Pre-operative Exercise Prescription and Physical Activity Promotion for Clinicians and Exercise Professionals. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Seward MW, Briggs LG, Bain PA, Chen AF. Preoperative Nonsurgical Weight Loss Interventions Before Total Hip and Knee Arthroplasty: A Systematic Review. J Arthroplasty 2021; 36:3796-3806.e8. [PMID: 34247869 DOI: 10.1016/j.arth.2021.06.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An upcoming total joint arthroplasty (TJA) may motivate patients with severe obesity (body mass index [BMI] > 40 kg/m2) to lose weight. Weight loss can optimize outcomes following TJA, and many surgeons use a 40 kg/m2 cut-off for undergoing TJA to reduce the risk of complications. However, few patients who are denied TJA for severe obesity successfully lose weight. This is the first systematic review of nonsurgical weight loss interventions before TJA. METHODS Five electronic databases were searched for articles on January 11, 2021. Studies that utilized preoperative nonsurgical weight loss interventions for patients with obesity (BMI ≥ 30 kg/m2) scheduled for or awaiting TJA of the hip or knee were included. Two reviewers independently screened articles, assessed methodological quality, and extracted data. RESULTS We retrieved 1943 unique records, of which 7 met inclusion criteria including 2 randomized clinical trials and 5 single-arm case series. Overall, weight loss ranged from 5.0 to 32.5 kg. Four interventions reduced BMI by 3 kg/m2 at 3-5 months, while 1 reduced BMI by 12.7 kg/m2. Other weight outcomes and those related to pain, function, complications, and adverse events were inconsistently reported. CONCLUSION Although larger trials are needed, particularly randomized controlled trials that measure preoperative weight loss in a control group, nutritional status, and postoperative complications, the available evidence indicates that short-term, nonsurgical, preoperative weight loss interventions before TJA produce both statistically significant weight loss and reduced BMI before surgery. It remains unknown if the amount of weight loss from these interventions is clinically significant and sufficient to improve outcomes after TJA.
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Affiliation(s)
- Michael W Seward
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Antonescu I, Haines KL, Agarwal S. Role of Nutrition in the Elderly Surgical Patient – Review of the Literature and Current Recommendations. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-021-00367-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reudink M, Molenaar CJL, Bonhof CS, Janssen L, Mols F, Slooter GD. Evaluating the longitudinal effect of colorectal surgery on health-related quality of life in patients with colorectal cancer. J Surg Oncol 2021; 125:217-226. [PMID: 34569626 PMCID: PMC9292688 DOI: 10.1002/jso.26685] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 12/09/2022]
Abstract
Background and Objectives Surgery for colorectal cancer (CRC) negatively affects health‐related quality of life (HRQoL). Addressing shortcomings in literature, the purpose of this study was to evaluate the impact of surgery for CRC on the course of HRQoL from baseline up to 2 years after diagnosis. Methods In this prospective, population‐based study patients with newly diagnosed CRC were included between 2016 and 2019. HRQoL was assessed by the EORTC QLQ‐C30 questionnaire over time both between and within subgroups of patients that underwent right‐sided colonic, left‐sided colonic, and rectal resection using linear mixed model analyses. Results The study included 415 patients of whom 148 patients underwent right‐sided colonic (36%), 147 left‐sided colonic (35%), and 120 rectal resection (29%). Overall, HRQoL scores restored to baseline level 1 year after diagnosis. Impact of surgery seems to be more prominent in patients who underwent rectal resection, as they experienced more pain and had worse role and social functioning scores 4 weeks after surgery. Finally, among patients who underwent left‐sided and rectal resection, physical functioning did not return to baseline level during follow‐up. Conclusion This study shows several differences (between‐group and within‐group) in HRQoL according to surgery type and offers perspective which patients may need additional support in the care pathway.
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Affiliation(s)
- Muriël Reudink
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | | | - Cynthia S Bonhof
- Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychological and Somatic disorders, Tilburg University, Tilburg, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Floortje Mols
- Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychological and Somatic disorders, Tilburg University, Tilburg, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
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Pope JE, Fishman MA, Gunn JA, Cotten BM, Hill MM, Deer TR. Cross-Validation of the Foundation Pain Index with PROMIS-29 in Chronic Pain Patients. J Pain Res 2021; 14:2677-2685. [PMID: 34512007 PMCID: PMC8412832 DOI: 10.2147/jpr.s314021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Discovery and validation of pragmatic biomarkers represent significant advancements in the field of pain management. Evaluating relationships between objective biomarkers and patient-reported outcomes (PROs) is an effective way to gain mechanistic insight into the potential role of biochemistry in chronic pain. The aim of this study was to validate the Foundation Pain Index (FPI) by evaluating associations between deranged biochemical function and PROMIS-29 domains in individuals living with chronic pain. Patients and Methods PROMIS-29 scores and FPI test results were obtained from 298 patients with chronic pain in this retrospective, observational study. Statistical analysis was performed using clinical test data to evaluate relationships between deranged biochemical function and quality of life measures across 8 universal domains. Results FPI scores significantly associated with multiple PROMIS-29 domains including physical function, impact score, fatigue, pain interference, and depression (P < 0.05). Moreover, specific analytes that comprise the FPI significantly correlated with PROMIS-29 domains, including 5-hydroxyindolacetic acid (pain interference, physical function, and pain impact scores), hydroxymethylglutarate (physical function), homocysteine (pain impact scores), kynurenic acid (pain interference and physical function), and quinolinic acid (physical function) (P < 0.05). Conclusion Cross-validation of the FPI with PROMIS-29 domains further supports the role of deranged biochemical function in the etiology of chronic pain. Objective identification of atypical biochemical function and subsequent correction holds tremendous promise for the non-opioid management of pain. Continued research efforts will aim to determine the impact of biochemical optimization in pre-surgical periods and post-surgical outcomes in patients with chronic pain.
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Affiliation(s)
| | | | - Joshua A Gunn
- Ethos Research and Development, LLC, Newport, KY, USA
| | | | | | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Franssen RFW, Janssen-Heijnen MLG, Barberan-Garcia A, Vogelaar FJ, Van Meeteren NLU, Bongers BC. Moderate-intensity exercise training or high-intensity interval training to improve aerobic fitness during exercise prehabilitation in patients planned for elective abdominal cancer surgery? Eur J Surg Oncol 2021; 48:3-13. [PMID: 34600787 DOI: 10.1016/j.ejso.2021.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/27/2021] [Accepted: 08/22/2021] [Indexed: 01/01/2023] Open
Abstract
Low preoperative aerobic fitness is associated with an increased risk of postoperative complications and delayed recovery in patients with abdominal cancer. Surgical prehabilitation aims to increase aerobic fitness preoperatively to improve patient- and treatment-related outcomes. However, an optimal physical exercise training program that is effective within the short time period available for prehabilitation (<6 weeks) has not yet been established. In this comparative review, studies (n = 8) evaluating the effect of short-term (<6 weeks) moderate-intensity exercise training (MIET) or high-intensity interval training (HIIT) on objectively measured aerobic fitness were summarized. The content of exercise interventions was critically appraised regarding the frequency, intensity, time, type, volume, and - monitoring of - progression (FITT-VP) principles. Three out of four studies evaluating HIIT showed statistically significant improvements in oxygen uptake at peak exercise (VO2peak) by more than 4.9%, the coefficient of variation for VO2peak. None of the two studies investigating short-term MIET showed statistically significant pre-post changes in VO2peak. Although short-term HIIT seems to be a promising intervention, concise description of performed exercise based on the FITT-VP principles was rather inconsistent in studies. Hence, interpretation of the results is challenging, and a translation into practical recommendations is premature. More emphasis should be given to individual responses to physical exercise training. Therefore, adequate risk assessment, personalized physical exercise training prescription using the FITT-VP principles, full reporting of physical exercise training adherence, and objective monitoring of training progression and recovery is needed to ensure for a personalized and effective physical exercise training program within a multimodal prehabilitation program.
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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Anael Barberan-Garcia
- Respiratory Medicine Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Spain
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Nico L U Van Meeteren
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands; Top Sector Life Sciences and Health (Health∼Holland), The Hague, the Netherlands
| | - Bart C Bongers
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Dagorno C, Sommacale D, Laurent A, Attias A, Mongardon N, Levesque E, Langeron O, Rhaiem R, Leroy V, Amaddeo G, Brustia R. Prehabilitation in hepato-pancreato-biliary surgery: A systematic review and meta-analysis. A necessary step forward evidence-based sample size calculation for future trials. J Visc Surg 2021; 159:362-372. [PMID: 34489200 DOI: 10.1016/j.jviscsurg.2021.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Prehabilitation is defined as preoperative conditioning of patients in order to improve post-operative outcomes. Some studies showed an increase in functional recovery following colorectal surgery, but its effect in hepato-pancreato-biliary (HPB) surgery is unclear. The aim of this study was to realize a systematic literature review and meta-analysis on the current available evidence on prehabilitation in HPB surgery. MATERIALS AND METHODS A systematic review and a metanalysis were carried out on prehabilitation (physical, nutritional and psychological interventions) in HPB surgery (2009-2019). Assessed outcomes were postoperative complications, length of stay (LOS), 30-day readmission, and mortality. MAIN RESULTS Four studies among the 191 screened were included in this systematic review (3 randomized controlled trials, 1 case-control propensity score study), involving 419 patients (prehabilitation group, n=139; control group, n=280). After pooling, no difference was observed on LOS ((-4.37 days [95% CI: -8.86; 0.13]) or postoperative complications (RR 0.83 [95%CI: 0.62; 1.10]), reported by all the included studies. Two trials reported on readmission rate, but given the high heterogeneity, a meta-analysis was not realized. No deaths were reported among the included studies. CONCLUSION No effect of prehabilitation programs in HPB surgery was observed on LOS or postoperative complications rate. Future trials with standardized outcomes of measure, and adequately powered samples calculations are thus required. PROSPERO REGISTRATION CRD42020165218.
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Affiliation(s)
- C Dagorno
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - D Sommacale
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; Inserm U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", France-Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - A Laurent
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - A Attias
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - N Mongardon
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; U955-IMRB, Equipe 03 "Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)", Inserm, University Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), 94700 Maisons-Alfort, France
| | - E Levesque
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - O Langeron
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - R Rhaiem
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, Reims, France
| | - V Leroy
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Inserm U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", France-Assistance Publique-Hôpitaux de Paris, Créteil, France; Department of Hepatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - G Amaddeo
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Inserm U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", France-Assistance Publique-Hôpitaux de Paris, Créteil, France; Department of Hepatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - R Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
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Dewulf M, Verrips M, Coolsen MME, Olde Damink SWM, Den Dulk M, Bongers BC, Dejong K, Bouwense SAW. The effect of prehabilitation on postoperative complications and postoperative hospital stay in hepatopancreatobiliary surgery a systematic review. HPB (Oxford) 2021; 23:1299-1310. [PMID: 34039535 DOI: 10.1016/j.hpb.2021.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increasing numbers of high-risk (older and/or frail) patients are undergoing hepatopancreatobiliary (HPB) surgery. Therefore, optimization of the patient's psychophysiological capacity by prehabilitation is rapidly gaining importance. The aim of this study was to collect all available evidence on prehabilitation in HPB surgery and determine its effects on postoperative complications and length of hospital stay. METHODS A systematic review was performed according to PRISMA guidelines. The electronic databases MEDLINE, Web of Science, Embase, CENTRAL, clinicaltrials.gov, and the international clinical trials registry platform (ICTRP) were searched from inception to April 2020. Methodological quality of included studies was assessed using the Cochrane Collaboration's tool for assessing risk of bias and the ROBINS-I tool. RESULTS Seven articles including a total of 1377 patients were included in the quality analysis. A trend towards less complications and a shorter hospital stay was seen in the prehabilitation group, but current evidence fails to demonstrate a statistically significant difference between groups. Risk of bias in included studies was variable, and was generally scored as moderate. CONCLUSION Strong evidence for the beneficial effect of prehabilitation on clinical outcomes in HPB surgery is lacking. A trend towards less complications and shorter hospital stay was seen in the prehabilitation group.
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Affiliation(s)
- Maxime Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Mared Verrips
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marielle M E Coolsen
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Den Dulk
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kees Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Stefan A W Bouwense
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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Rammant E, Van Hecke A, Decaestecker K, Albersen M, Joniau S, Everaerts W, Jansen F, Mohamed NE, Colman R, Van Hemelrijck M, Fonteyne V. Supportive care needs and utilization of bladder cancer patients undergoing radical cystectomy: A longitudinal study. Psychooncology 2021; 31:219-226. [PMID: 34449941 DOI: 10.1002/pon.5795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Investigating supportive care (SC) needs and utilization/willingness to use SC services from diagnosis to one year after radical cystectomy in bladder cancer (BC) patients. MATERIALS & METHODS: A longitudinal cohort study was conducted in 90 BC patients at Ghent/Leuven University Hospitals between April 2017 and December 2020. The Supportive Care Needs Survey-short form (SCNS-SF34) was used before radical cystectomy, one, three, six and 12 months after radical cystectomy. Additional questions assessed utilization/willingness to use SC services. Linear mixed models were performed. RESULTS The majority of BC patients report at least one moderate or high SC need at diagnosis (82%), month 1 (84%), month 3 (86%), month 6 (64%), and month 12 (60%). Significant decreases over time were seen for all domains (p < 0.001), except for sexuality (p = 0.275). From baseline to month 1, physical needs first significantly increased (p = 0.001) after which they decreased. Psychological (e.g. fears about the future) and informational (e.g. information on how to get better) needs were most common at baseline whereas physical (e.g. lack of energy) and informational needs were more common in the early postoperative phases. The majority of patients (ranging from 81% (month 1) to 91% (month 12)) did not make use of SC services and the majority of the patients (ranging from 81% (month 1) to 88% (month 12)) did not wish to talk about their problems to someone. Those willing to talk to someone preferred their physician. CONCLUSIONS A clear gap exists between the large proportion of SC needs experienced by BC patients undergoing radical cystectomy and the low use of SC services.
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Affiliation(s)
- Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Staff Member Nursing, Ghent University Hospital, Ghent, Belgium
| | | | - Maarten Albersen
- Department of Urology, Leuven University Hospitals, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, Leuven University Hospitals, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, Leuven University Hospitals, Leuven, Belgium
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Nihal E Mohamed
- Department of Urology and Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Roos Colman
- Department of Public Health and Primary Care, Biostatistics Unit, Ghent University, Ghent, Belgium
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), King's College London, London, UK
| | - Valérie Fonteyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Citrulline, Biomarker of Enterocyte Functional Mass and Dietary Supplement. Metabolism, Transport, and Current Evidence for Clinical Use. Nutrients 2021; 13:nu13082794. [PMID: 34444954 PMCID: PMC8398474 DOI: 10.3390/nu13082794] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022] Open
Abstract
L-Citrulline is a non-essential but still important amino acid that is released from enterocytes. Because plasma levels are reduced in case of impaired intestinal function, it has become a biomarker to monitor intestinal integrity. Moreover, oxidative stress induces protein citrullination, and antibodies against anti-citrullinated proteins are useful to monitor rheumatoid diseases. Citrullinated histones, however, may even predict a worse outcome in cancer patients. Supplementation of citrulline is better tolerated compared to arginine and might be useful to slightly improve muscle strength or protein balance. The following article shall provide an overview of L-citrulline properties and functions, as well as the current evidence for its use as a biomarker or as a therapeutic supplement.
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Impact of Smoking and Drinking on Complications After Revision Total Joint Arthroplasty: A Matched Cohort Analysis. J Am Acad Orthop Surg 2021; 29:e769-e781. [PMID: 32947345 DOI: 10.5435/jaaos-d-20-00795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/18/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Smoking and drinking have been shown to impair postoperative outcomes in primary hip and knee total joint arthroplasty (TJA). This study aimed to evaluate the potential impact of smoking and drinking on complications after revision TJA. METHODS We retrospectively evaluated a total of 4,302 consecutive patients who underwent revision TJA. Patient demographics and complications were compared between four cohorts based on smoking and drinking status: (1) nonusers (nonsmokers and nondrinkers), (2) smokers, (3) drinkers, and (4) concurrent users. RESULTS A total of 1,924 patients were matched using propensity score analysis: 808 nonusers (42.0%), 421 smokers (21.9%), 483 drinkers (25.0%), and 212 concurrent users (11.1%). When compared with nonusers, smokers, drinkers, and concurrent users (simultaneous smokers and drinkers) exhibited higher odds for both inhospital complications (odds ratios, smokers: 2.40, drinkers: 1.55, and concurrent users: 5.13, P < 0.01). Among the user cohorts, although smokers and drinkers showed similar rates of 90-day postdischarge complications (smokers: 14.95% and drinkers: 14.80%, P = 0.95), concurrent users demonstrated the highest significant odds for these complications (odds ratio, 1.64, P = 0.02). DISCUSSION Our propensity-score-matched cohort study results demonstrate that although the smokers and drinkers groups shared similarly poor outcomes after discharge, concurrent users were found to have the worst outcomes compared with either single user group.
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Alexandre L, Costa RS, Santos LL, Henriques R. Mining Pre-Surgical Patterns Able to Discriminate Post-Surgical Outcomes in the Oncological Domain. IEEE J Biomed Health Inform 2021; 25:2421-2434. [PMID: 33687853 DOI: 10.1109/jbhi.2021.3064786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Understanding the individualized risks of undertaking surgical procedures is essential to personalize preparatory, intervention and post-care protocols for minimizing post-surgical complications. This knowledge is key in oncology given the nature of interventions, the fragile profile of patients with comorbidities and cytotoxic drug exposure, and the possible cancer recurrence. Despite its relevance, the discovery of discriminative patterns of post-surgical risk is hampered by major challenges: i) the unique physiological and demographic profile of individuals, as well as their differentiated post-surgical care; ii) the high-dimensionality and heterogeneous nature of available biomedical data, combining non-identically distributed risk factors, clinical and molecular variables; iii) the need to generalize tumors have significant histopathological differences and individuals undertake unique surgical procedures; iv) the need to focus on non-trivial patterns of post-surgical risk, while guaranteeing their statistical significance and discriminative power; and v) the lack of interpretability and actionability of current approaches. Biclustering, the discovery of groups of individuals correlated on subsets of variables, has unique properties of interest, being positioned to satisfy the aforementioned challenges. In this context, this work proposes a structured view on why, when and how to apply biclustering to mine discriminative patterns of post-surgical risk with guarantees of usability, a subject remaining unexplored up to date. These patterns offer a comprehensive view on how the patient profile, cancer histopathology and entailed surgical procedures determine: i) post-surgical complications, ii) survival, and iii) hospitalization needs. The gathered results confirm the role of biclustering in comprehensively finding interpretable, actionable and statistically significant patterns of post-surgical risk. The found patterns are already assisting healthcare professionals at IPO-Porto to establish specialized pre-habilitation protocols and bedside care.
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van der Zanden V, van der Zaag-Loonen HJ, Paarlberg KM, Meijer WJ, Mourits MJE, van Munster BC. PREsurgery thoughts - thoughts on prehabilitation in oncologic gynecologic surgery, a qualitative template analysis in older adults and their healthcare professionals. Disabil Rehabil 2021; 44:5930-5940. [PMID: 34283686 DOI: 10.1080/09638288.2021.1952319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to reveal information that can be used for composing a prehabilitation program tailored to elderly gynecological oncological patients and is applicable to healthcare professionals. We investigated possible content and indications for prehabilitation, and what potential barriers might exist. MATERIALS AND METHODS Because of the primary exploratory study aim, inductive thematic template analysis on semi-structured interviews with gynecologic oncological patients aged ≥60 years and healthcare professionals were used. RESULTS 16 patients and 20 healthcare professionals were interviewed. Three themes important for prehabilitation were found: (1) "Motivation," (2) "Practical issues and facilitators," and (3) "Patient-related factors." A short time interval between diagnosis and surgery was reported as a potential barrier for prehabilitation. Given components for a tailor-made prehabilitation program are: (1) The first contact with a nurse who screens the patients, gives tailor-made advice on prehabilitation and keeps patients motivated and supports them mentally; (2) If patients are referred to a more extensive/supervised program, this should preferably be arranged close to a patients' home. CONCLUSION Based on our findings, an outline of a patient-tailored prehabilitation program was developed. The main important themes for prehabilitation were "Motivation," "Practical issues and facilitators," and "Patient-related factors."IMPLICATIONS FOR REHABILITATIONPatients and healthcare professionals are positive about prehabilitation.Main themes for designing a prehabilitation program are "Motivation," "Practical issues and facilitators," and "Patient-related factors."Nursing staff can play a key role in prehabilitation.It is important to screen patients for specific impairments to obtain a tailor-made prehabilitation program.For some patients, general advice on prehabilitation might be sufficient, while others may need more supervision.The time interval between diagnosis and surgery is often short and is perceived as a potentially significant barrier for an effective prehabilitation program.
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Affiliation(s)
- Vera van der Zanden
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands.,Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hester J van der Zaag-Loonen
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K Marieke Paarlberg
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Wouter J Meijer
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Marian J E Mourits
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Beck A, Vind Thaysen H, Hasselholt Soegaard C, Blaakaer J, Seibaek L. What matters to you? An investigation of patients' perspectives on and acceptability of prehabilitation in major cancer surgery. Eur J Cancer Care (Engl) 2021; 30:e13475. [PMID: 34106493 DOI: 10.1111/ecc.13475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/26/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To understand perspectives on and acceptability of prehabilitation among patients undergoing complex abdominal cancer surgery (cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy). METHODS Seventy-nine patients admitted to a Danish colorectal or ovarian cancer centre participated in qualitative semi-structured interviews and/or registered their prehabilitation activities based on preoperative recommendations presented in a leaflet. Malterud's principles of systematic text condensation were used to analyse the interview data, and descriptive statistics were used to describe the activity registrations. RESULTS Five domains clarify central aspects of the patients' perspectives on and acceptability of prehabilitation: the preoperative period, attitudes towards prehabilitation, the actual prehabilitation performed, motivation to take action and the need for support. CONCLUSION Patients undergoing major abdominal cancer surgery are interested in and positive towards prehabilitation, but it has to be on their terms. The patients need support and supervision, but it has to be provided in a setting and in a way that are in line with the patient's preferences, resources and values. Thus, patient involvement is necessary to create prehabilitation programmes that are feasible and fit into patients' everyday lives.
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Affiliation(s)
- Anne Beck
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
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Finley DJ, Stevens CJ, Emond JA, Batsis JA, Fay KA, Darabos C, Sacks OA, Cook SB, Lyons KD. Potential effectiveness of a surgeon-delivered exercise prescription and an activity tracker on pre-operative exercise adherence and aerobic capacity of lung cancer patients. Surg Oncol 2021; 37:101525. [PMID: 33813267 PMCID: PMC8217197 DOI: 10.1016/j.suronc.2021.101525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/10/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pre-operative exercise may improve functional outcomes for lung cancer patients, but barriers associated with cost, resources, and burden make it challenging to deliver pre-operative exercise programs. The goal of this proof-of-concept study was to determine level of moderate-vigorous physical activity (MVPA) and change in aerobic capacity after participation in a home-based pre-operative exercise intervention. MATERIALS AND METHODS Eighteen patients scheduled for surgery for suspected stage I-III lung cancer received an exercise prescription from their surgeon and wore a commercially-available device that tracked their daily MVPA throughout the pre-operative period. Descriptive statistics were used to calculate adherence to the exercise prescription. A one-sample t-test was used to explore change in aerobic capacity from baseline to the day of surgery. RESULTS Participants exhibited a mean of 20.4 (sd = 46.2) minutes of MVPA per day during the pre-operative period. On average, the sample met the goal of 30 min of MVPA on 16.4% of the days during the pre-operative period. The mean distance achieved at baseline for the 6-min walk test was 456.7 m (sd = 72.9), which increased to 471.1 m (sd = 88.4) on the day of surgery. This equates to a mean improvement of 13.8 m (sd = 37.0), but this difference was not statistically different from zero (p = 0.14). Eight of the 17 participants (47%) demonstrated a clinically significant improvement of 14 m or more. CONCLUSION A surgeon-delivered exercise prescription plus an activity tracker may promote clinically significant improvement in aerobic capacity and MVPA engagement among patients with lung cancer during the pre-operative period, but may need to be augmented with more contact with and support from practitioners over time to maximize benefits. TRIAL REGISTRATION The study protocol was registered with ClinicalTrials.gov prior to initiating participant recruitment (NCT03162718).
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Affiliation(s)
- David J Finley
- Department of Surgery, Section Thoracic Surgery, Dartmouth-Hitchcock Health, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Courtney J Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Health, Dartmouth Centers for Health & Aging, 46 Centerra Parkway, Lebanon, NH, 03756, USA.
| | - Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - John A Batsis
- Department of Medicine, Dartmouth-Hitchcock Health, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Health, 1 Medical Center Dr., Lebanon, NH, 03756, USA.
| | - Christian Darabos
- Information, Technology and Consulting, Dartmouth College, 4 Currier Place, Hanover, NH, 03748, USA; Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Olivia A Sacks
- Department of Surgery, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, 02118, USA.
| | - Summer B Cook
- Department of Kinesiology, University of New Hampshire, 124 Main Street, Durham, NH, 03824, USA.
| | - Kathleen Doyle Lyons
- Department of Psychiatry Research, Dartmouth-Hitchcock Health, 1 Medical Center Dr., Lebanon, NH, 03756, USA.
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Briggs LG, Reitblat C, Bain PA, Parke S, Lam NY, Wright J, Catto JWF, Copeland RJ, Psutka SP. Prehabilitation Exercise Before Urologic Cancer Surgery: A Systematic and Interdisciplinary Review. Eur Urol 2021; 81:157-167. [PMID: 34074558 DOI: 10.1016/j.eururo.2021.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023]
Abstract
CONTEXT The Consensus on Therapeutic Exercise Training (CONTENT) scale assesses the therapeutic validity of exercise programs. To date, prehabilitation exercise programs for heath optimization before urologic cancer surgeries have not been assessed for therapeutic validity or efficacy. OBJECTIVE To systematically assess prehabilitation exercise programs before urologic cancer surgery for therapeutic validity and efficacy, informing discussion of best practices for future intervention. EVIDENCE ACQUISITION A systematic review was performed using Ovid, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases through June 2020. The review included prospective (randomized controlled and uncontrolled) trials where patients were enrolled in prehabilitation exercise programs before urologic cancer surgery. The primary outcomes of interest included therapeutic validity and efficacy (measures of cardiorespiratory fitness and postsurgical outcomes). Studies were evaluated for the risk of bias. A narrative synthesis was carried out given heterogeneity in populations, interventions, and outcomes across studies. EVIDENCE SYNTHESIS Ten unique studies and two associated post hoc analyses met the inclusion criteria. Seven studies demonstrated therapeutic validity. Eight demonstrated a high risk of bias. All demonstrated significant improvement in cardiorespiratory fitness. Four of five studies evaluating quality of life observed significant improvements. To date, zero trials have demonstrated reduction in postsurgical complications, mortality, length of stay, or readmission rates following prehabilitation exercise interventions. CONCLUSIONS While prehabilitation exercise may result in improved cardiorespiratory fitness and quality of life, current studies have yet to demonstrate impact on surgical outcomes. When designing prehabilitation exercise programs for use before urologic cancer surgery, the therapeutic validity of the intervention should be considered. Future prehabilitation studies should employ standardized content rubrics to ensure therapeutic validity. Consensus is needed regarding the appropriate outcomes to adjudicate prehabilitation efficacy. PATIENT SUMMARY In this report, we looked at the effectiveness and quality of prehabilitation exercise programs before urologic cancer surgery. We found that these programs effectively improve presurgical fitness, but may benefit from the use of structured methodology and outcome assessment to understand their potential to improve surgical outcomes.
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Affiliation(s)
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Sara Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, AZ, USA
| | - Ny-Ying Lam
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA, USA
| | - Jonathan Wright
- Department of Urology, University of Washington, Seattle, WA, USA
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Robert J Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA.
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Piraux E, Reychler G, de Noordhout LM, Forget P, Deswysen Y, Caty G. What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? A systematic review. BMC Sports Sci Med Rehabil 2021; 13:33. [PMID: 33766107 PMCID: PMC7993458 DOI: 10.1186/s13102-021-00260-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/17/2021] [Indexed: 01/10/2023]
Abstract
Background Substantial postoperative complications occur after tumor resection for esophagogastric cancers. Physical prehabilitation programs aim to prepare patients for surgery by improving their functional status with the aim of reducing postoperative complications. This systematic review aims to summarize the effects of physical prehabilitation programs on exercise capacity, muscle strength, respiratory muscle function, postoperative outcomes, and health-related quality of life and to determine the optimal design of such a program to improve these outcomes in esophagogastric cancer patients undergoing tumor resection. Methods A systematic literature review was conducted using PubMed, The Cochrane Library, Scopus, and PEDro databases to identify studies evaluating the effects of physical prehabilitation program on exercise capacity, muscle strength, respiratory muscle function, postoperative complications, length of hospital stay, mortality, and health-related quality of life in patients with esophagogastric cancer awaiting surgery. Data from all studies meeting the inclusion criteria were extracted. The quality of each selected study was determined using the Downs and Black checklist. Results Seven studies with 645 participants were included. The preoperative exercise program consisted of respiratory training alone in three studies, a combination of aerobic and resistance training in two studies, and a combination of respiratory, aerobic, and resistance training in two studies. Training frequency ranged from three times a day to twice a week and each session lasted between 20 and 75 min. Four studies were of fair quality and three of good quality. Some studies reported improvements in maximal inspiratory pressure, inspiratory muscle endurance, postoperative (pulmonary) complications, and length of hospital stay in the preoperative exercise group compared to the control group. Conclusion This systematic review reports the current evidence for physical prehabilitation programs in patients with esophagogastric cancer awaiting surgery. However, due to the limited number of randomized controlled trials, the significant heterogeneity of exercise programs, and the questionable quality of the studies, higher quality randomized controlled trials are needed. Trial registration PROSPERO Registration Number: CRD42020176353. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00260-w.
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Affiliation(s)
- Elise Piraux
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab, Université catholique de Louvain, Avenue Mounier 53, bte B1.53.07, 1200, Brussels, Belgium. .,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. .,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium.
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Haute Ecole Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium.,Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Louise Maertens de Noordhout
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab, Université catholique de Louvain, Avenue Mounier 53, bte B1.53.07, 1200, Brussels, Belgium.,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium
| | - Patrice Forget
- Department of Anaesthetics, Institute of Applied Health Sciences, Epidemiology Group, University of Aberdeen, NHS Grampian, Aberdeen, UK
| | - Yannick Deswysen
- Upper Gastrointestinal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gilles Caty
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab, Université catholique de Louvain, Avenue Mounier 53, bte B1.53.07, 1200, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Matthews L, Bates A, Wootton SA, Levett D. The use of bioelectrical impedance analysis to predict post-operative complications in adult patients having surgery for cancer: A systematic review. Clin Nutr 2021; 40:2914-2922. [PMID: 33962360 DOI: 10.1016/j.clnu.2021.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients undergoing surgery for cancer are at particular risk of post-operative complications. The pre-operative period is an opportunity to identify and mitigate risk factors and improve outcome. Bioelectrical impedance analysis (BIA) may offer an additional means of identifying patients at risk of post-operative morbidity. AIMS The aim of this systematic review was to assess the use of measures and estimates of body composition determined by BIA as markers of peri-operative risk in adult patients undergoing elective surgery for cancer. METHODS This review was performed in accordance with the PRISMA guidelines. The electronic databases of MEDLINE, EMBASE, CINAHL, CENTRAL and the Web of Science were searched from inception. Studies of adult participants having elective surgery for cancer were included if participants underwent BIA in the peri-operative period and were assessed for post-operative complications. RESULTS 2578 studies were identified, of which 12 were eligible for inclusion. In total the studies report data from 1508 subjects. Five studies examined phase angle or standardized phase angle, six examined derived measures and one examined both. Eight of the 12 demonstrated an association between phase angle and/or body composition and an increased risk of post-operative complications. CONCLUSIONS Bioelectrical impedance analysis in the peri-operative period may be useful in predicting the risk of complications following elective cancer surgery. Phase angle more consistently demonstrates an association than derived estimates. Further high quality studies are needed and should report the raw impedance values, standardized phase angle and the equations used to derive body composition.
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Affiliation(s)
- L Matthews
- Department of Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK; University of Southampton, Southampton, UK.
| | - A Bates
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S A Wootton
- University of Southampton, Southampton, UK; National Institute for Health Research Cancer and Nutrition Collaboration, UK
| | - D Levett
- Department of Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK; University of Southampton, Southampton, UK
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van Wijk L, van der Snee L, Buis CI, Hentzen JEKR, Haveman ME, Klaase JM. A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions. Perioper Med (Lond) 2021; 10:5. [PMID: 33593437 PMCID: PMC7887817 DOI: 10.1186/s13741-020-00175-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Despite improvements in perioperative care, major abdominal surgery continues to be associated with significant perioperative morbidity. Accurate preoperative risk stratification and optimisation (prehabilitation) are necessary to reduce perioperative morbidity. This study evaluated the screening and assessment of modifiable risk factors amendable for prehabilitation interventions and measured the patient compliance rate with recommended interventions. Method Between May 2019 and January 2020, patients referred to our hospital for HPB surgery were screened and assessed on six modifiable preoperative risk factors. The risk factors and screening tools used, with cutoff values, included (i) low physical fitness (a 6-min walk test < 82% of patient’s calculated norm and/or patient’s activity level not meeting the global recommendations on physical activity for health). Patients who were unfit based on the screening were assessed with a cardiopulmonary exercise test (anaerobic threshold ≤ 11 mL/kg/min); (ii) malnutrition (patient-generated subjective global assessment ≥ 4); (iii) iron-deficiency anaemia (haemoglobin < 12 g/dL for women, < 13 g/dL for men and transferrin saturation ≤ 20%); (iv) frailty (Groningen frailty indicator/Robinson frailty score ≥ 4); (v) substance use (smoking and alcohol use of > 5 units per week) and (vi) low psychological resilience (Hospital Anxiety and Depression Scale ≥ 8). Patients had a consultation with the surgeon on the same day as their screening. High-risk patients were referred for necessary interventions. Results One hundred consecutive patients were screened at our prehabilitation outpatient clinic. The prevalence of high-risk patients per risk factor was 64% for low physical fitness, 42% for malnutrition, 32% for anaemia (in 47% due to iron deficiency), 22% for frailty, 12% for smoking, 18% for alcohol use and 21% for low psychological resilience. Of the 77 patients who were eventually scheduled for surgery, 53 (68.8%) needed at least one intervention, of whom 28 (52.8%) complied with 100% of the necessary interventions. The median (IQR) number of interventions needed in the 77 patients was 1.0 (0–2). Conclusion It is feasible to screen and assess all patients referred for HPB cancer surgery for six modifiable risk factors. Most of the patients had at least one risk factor that could be optimised. However, compliance with the suggested interventions remains challenging. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-020-00175-z.
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Affiliation(s)
- Laura van Wijk
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands.
| | - Lizzel van der Snee
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Carlijn I Buis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Judith E K R Hentzen
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Marjolein E Haveman
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
| | - Joost M Klaase
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, PO Box 30001, 9700, RB, Groningen, The Netherlands
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74
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Fecher-Jones I. Preoperative education: making every contact count. Br J Hosp Med (Lond) 2021; 82:1-2. [PMID: 33646042 DOI: 10.12968/hmed.2020.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patient education is an important part of obtaining informed consent, but can also be used to educate patients about how to prepare for surgery and help them take responsibility for improving their own health to reduce their risk of perioperative complications.
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Affiliation(s)
- Imogen Fecher-Jones
- Perioperative Medicine Team, University Hospital Southampton, Southampton, UK
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75
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Shan L. Preparing for Success. Eur J Vasc Endovasc Surg 2021; 61:766. [PMID: 33589323 DOI: 10.1016/j.ejvs.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Leonard Shan
- Department of Vascular Surgery, St. Vincent's Hospital, Melbourne, Australia.
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76
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Studying Enhanced Recovery After Surgery (ERAS®) Core Items in Colorectal Surgery: A Causal Model with Latent Variables. World J Surg 2021; 45:928-939. [PMID: 33575826 PMCID: PMC7921056 DOI: 10.1007/s00268-020-05940-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 01/30/2023]
Abstract
Background Previous Enhanced Recovery After Surgery (ERAS®) studies have not always taken into account that ERAS interventions depend on baseline covariates and that several confounding variables affect the composite outcomes. Method A causal latent variable model is proposed to analyze data obtained prospectively concerning 1261 patients undergoing elective colorectal surgery within the ERAS protocol. Primary outcomes (composite of any complication, surgical site infection, medical complications, early ready for discharge (TRD), early actual discharge) and secondary outcomes (composite of late bowel function recovery, IV fluid resumption, nasogastric tube replacement, postoperative nausea and vomiting, re-intervention, re-admission, death) are considered along with their multiple dimensions. Results Concerning the primary outcomes, our results evidence three subpopulations of patients: one with probable good outcome, one with possibly prolonged TRD and discharge without complications, and the other one with probable complications and prolonged TRD and discharge. Epidural anesthesia, waiving surgical drainage, and early ambulation, IV fluid stop and urinary catheter removal act favorably, while preoperative hospital stay and blood transfusion act negatively. Concerning the secondary outcomes our results evidence two subpopulations of patients: one with high probability of good outcome and one with high probability of complications. Epidural anesthesia, waiving surgical drainage, early ambulation and IV fluid stop act favorably, while blood transfusion acts negatively also with respect to these secondary outcomes. Conclusion The multivariate causal latent class two-parameter logistic model, a modern statistical method overcoming drawbacks of traditional models to estimate the average causal effects on the treated, allows us to disentangle subpopulations of patients and to evaluate ERAS interventions.
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77
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Larson DW, Abd El Aziz MA, Perry W, Behm KT, Shawki S, Mandrekar J, Mathis KL, Grass F. Surgical Resection for Crohn's and Cancer: A Comparison of Disease-Specific Risk Factors and Outcomes. Dig Surg 2021; 38:120-127. [PMID: 33503622 DOI: 10.1159/000511909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The goal of this study was to compare disease-specific risk factors and 30-day outcomes between patients with Crohn's disease (CD) and colon cancer (CC) undergoing right-sided surgical resection. METHODS The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP®) was interrogated to extract all patients ≥18 years undergoing elective right-sided resection for CD versus CC. Independent risk factors for surgical complications were identified through multivariable logistic regression for both groups. In a second step, surgical and medical 30-day morbidity was compared after risk adjustment. RESULTS The cohort consisted of 17,516 patients, of which 2,899 (16.6%) underwent surgery for CD versus 14,617 (83.4%) for CC. Independent risk factors for surgical complications in patients with CD were male gender, African American race, ASA score (III or IV), active smoking, prolonged surgery, and preoperative anemia. Independent risk factors for surgical complications in the cancer group were age ≥70 years, male gender, ASA score (III or IV), respiratory and cardiovascular comorbidities, and preoperative hypoalbuminemia (<3.5 g/dL). After risk adjustment, surgical complications (OR 1.25, p = 0.002), sepsis (OR 1.64, p = 0.012), and unplanned readmissions (OR 1.39, p = 0.004) were more common in patients with CD. Thirty-day mortality was higher in cancer patients (1.1 vs. 0.1%, p < 0.0001). CONCLUSIONS Patients with Crohn's disease were more prone to surgical complications and postoperative sepsis compared to the cancer group undergoing the same procedure. Careful evaluation and correction of disease-specific modifiable risk factors of patients with CD and CC, respectively, are important.
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Affiliation(s)
- David W Larson
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamed A Abd El Aziz
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William Perry
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin T Behm
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sherief Shawki
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jay Mandrekar
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland,
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78
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Jensen BT, Lauridsen SV, Scheede-Bergdahl C. The Potential of Prehabilitation in Radical Cystectomy Pathways: Where Are We Now? Semin Oncol Nurs 2021; 37:151107. [PMID: 33446382 DOI: 10.1016/j.soncn.2020.151107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The growing recognition of prehabilitation has caused an emerging paradigm shift in surgical cancer care and an integrated component of the cancer care continuum. This narrative review aims to update and inform the urological community of the potential of prehabilitation before radical cystectomy. DATA SOURCES A nonsystematic narrative review was performed through a database search in PubMed, and CINAHL using the following search terms: enhanced recovery after surgery (ERAS); Frailty; Prehabilitation and/or Rehabilitation; Physical Activity and/or exercises; Nutrition; Nutritional Care; Smoking cessation; Alcohol cessation; Prevention; Supportive Care; and combined with Radical Cystectomy. CONCLUSION A multimodal and multi-professional approach during the preoperative period may offer an opportunity to preserve or enhance physiological integrity and optimize surgical recovery. Studies indicate a positive effect of prehabilitation on postoperative functional capacity and earlier return to daily activities and health related quality of life. Meaningful outcomes that reflect recovery from a patient's perspective and clinical outcome measures, as well as validating metrics, are necessary to establish whether prehabilitation diminish the risk of developing long-term disability in high-risk patients. IMPLICATIONS FOR NURSING PRACTICE Uro-oncology nurses are at the forefront in every ERAS program and vital in screening patients ahead of surgery for common risk factors, current impairments, and limitations that can compromise baseline functional capacity. The growing movement to standardize clinical implementation of prehabilitation, indicate there is a clear need for further investigation, optimization of a multimodal approach and an open discussion between health care providers from different areas of expertise who might best support and promote these initiatives.
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Affiliation(s)
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Denmark and WHO-CC, Parker Institute Bispebjerg & Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
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79
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van der Velde M, Valkenet K, Geleijn E, Kruisselbrink M, Marsman M, Janssen LM, Ruurda JP, van der Peet DL, Aarden JJ, Veenhof C, van der Leeden M. Usability and Preliminary Effectiveness of a Preoperative mHealth App for People Undergoing Major Surgery: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e23402. [PMID: 33410758 PMCID: PMC7819776 DOI: 10.2196/23402] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Major surgery is associated with negative postoperative outcomes such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mobile health (mHealth) could be an effective new approach. OBJECTIVE The objectives of this pilot study were to (1) evaluate the usability of the Be Prepared mHealth app prototype for people undergoing major surgery, (2) explore whether the app was capable of bringing about a change in risk behaviors, and (3) estimate a preliminary effect of the app on functional recovery after major surgery. METHODS A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total, 86 people undergoing major surgery participated. Participants in the intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires. Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about the usability of the app were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data. RESULTS Seventy-nine people-40 in the intervention group and 39 in the control group-were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that patients considered the Be Prepared app to have acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app. Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values (β=-2.4 [95% CI -5.9 to 1.1]). CONCLUSIONS The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified with which the app and future research can be optimized. TRIAL REGISTRATION Netherlands Trial Registry NL8623; https://www.trialregister.nl/trial/8623.
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Affiliation(s)
- Miriam van der Velde
- Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karin Valkenet
- Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjoke Kruisselbrink
- Clinical Health Sciences, Program Physiotherapy Sciences, Utrecht University, Utrecht, Netherlands
| | - Marije Marsman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Liedewij Mj Janssen
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Donald L van der Peet
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jesse J Aarden
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Cindy Veenhof
- Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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80
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Huynh C, Walsh LA, Spicer JD. Surgery after neoadjuvant immunotherapy in patients with resectable non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:563-580. [PMID: 33569337 PMCID: PMC7867741 DOI: 10.21037/tlcr-20-509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022]
Abstract
Surgery is the standard of care for patients with operable non-small cell lung cancer (NSCLC). However, as a single modality, surgery for early stage or locally advanced NSCLC remains associated with high rates of local and distant recurrence. The addition of neoadjuvant or adjuvant chemotherapy has modestly improved outcomes. While systemic therapy paired with surgery for other malignancies such as breast cancer have resulted in far better outcomes for equivalent stage designations, outcome improvements for operable NSCLC have lagged in part as a result of trials where adjuvant chemotherapy seemed to incur harm for stage IA patients and only modest survival benefit for stage IB-IIIA patients (AJCC 7th ed.). In recent years, immunotherapy for NSCLC has emerged as a systemic therapy with significant benefit over traditional chemotherapy regimens. These advances with immune checkpoint inhibitors (ICIs) have opened the door to administering peri-operative immunotherapy for operable NSCLC. As a result, a great multitude of studies investigating the use of immunotherapy in combination with surgery for NSCLC as well as several other malignancies have emerged. In this review, we outline the rationale for neoadjuvant immunotherapy in the treatment of operable NSCLC and summarize the available evidence that include preoperative ICI as a single modality or in combination with systemic agents and/or radiotherapy. Further, we summarize how such treatment trajectories open multiple unique windows of opportunity for scientific discovery and potential therapeutic gains for these vulnerable patients.
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Affiliation(s)
- Caroline Huynh
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal QC, Canada
| | - Logan A. Walsh
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Jonathan D. Spicer
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal QC, Canada
- Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
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81
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A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.cireng.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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82
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Gimeno-Santos E, Coca-Martinez M, Arguis MJ, Navarro R, Lopez-Hernandez A, Castel MA, Romano B, Lopez-Baamonde M, Sandoval E, Farrero M, Sanz M, Bofill A, Martinez-Palli G. Multimodal prehabilitation as a promising strategy for preventing physical deconditioning on the heart transplant waiting list. Eur J Prev Cardiol 2020; 27:2367-2370. [DOI: 10.1177/2047487319889709] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Elena Gimeno-Santos
- Respiratory Clinic Institute, Hospital Clinic de Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Maria J Arguis
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Anaesthesiology Department, Hospital Clínic de Barcelona, Spain
| | - Ricard Navarro
- Anaesthesiology Department, Hospital Clínic de Barcelona, Spain
| | | | - Maria A Castel
- Advanced Heart Failure and Transplant Unit, Cardiovascular Institute, Hospital Clinic de Barcelona, Spain
| | - Barbara Romano
- Nutrition and Clinical Dietetics, Hospital Clinic de Barcelona, Spain
| | | | - Elena Sandoval
- Cardiovascular Surgery Department, Hospital Clinic de Barcelona, Spain
| | - Marta Farrero
- Advanced Heart Failure and Transplant Unit, Cardiovascular Institute, Hospital Clinic de Barcelona, Spain
| | - Maria Sanz
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Cardiovascular Institute, Hospital Clinic de Barcelona, Spain
- Centro de Investigación Biomèdica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Bofill
- Donor Centre-Barcelona Tissue Bank, Hospital Clinic de Barcelona, Spain
| | - Graciela Martinez-Palli
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Anaesthesiology Department, Hospital Clínic de Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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83
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Konradsen AA, Lund CM, Vistisen KK, Albieri V, Dalton SO, Nielsen DL. The influence of socioeconomic position on adjuvant treatment of stage III colon cancer: a systematic review and meta-analysis. Acta Oncol 2020; 59:1291-1299. [PMID: 32525420 DOI: 10.1080/0284186x.2020.1772501] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with colon cancer (CC) with low socioeconomic position (SEP) have a worse survival than patients with high SEP. We investigated the association between different socioeconomic indicators and the steps in the treatment trajectory leading to initiation of adjuvant chemotherapy (ACT) for patients with stage III CC. MATERIALS AND METHODS A systematic review and meta-analyses were conducted in accordance with the MOOSE checklist. MEDLINE and EMBASE were searched for eligible studies. Meta-analyses were performed on the separate socioeconomic indicators with the random-effects model. The heterogeneity across studies was assessed by the Q and the I 2 statistic. RESULTS In total, 27 observational studies were included. SEP was measured by insurance, income, poverty, employment, education, or an index on an area or individual level. SEP, regardless of indicator, was negatively associated with the steps in the treatment trajectory leading to initiation of ACT among patients with resected stage III CC. The meta-analyses showed that patients with low SEP had a significantly lower odds of receiving ACT and increased odds of delayed treatment start, whereas SEP had no impact on the choice of therapy: combination or single-agent therapy. CONCLUSION SEP was associated with less initiation of and higher risk for delayed initiation of ACT. Our findings suggest there is a social disparity in receipt of ACT in patients with stage III CC.
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Affiliation(s)
- A. A. Konradsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - C. M. Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Copenage, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - K. K. Vistisen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - V. Albieri
- Statistics and Data Analysis Department, Danish Cancer Society, Research Center, Copenhagen, Denmark
| | - S. O. Dalton
- Department of Clinical Oncology & Palliative Services, Zealand University Hospital, Naestved, Denmark
- Suvivorship and Inequality in Cancer, Danish Cancer Society, Research Center, Copenhagen, Denmark
| | - D. L. Nielsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
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84
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Argunova YA, Zvereva TN, Pomeshkina SA, Ivanova AV, Polikutina OM, Gruzdeva OV, Kashtalap VV, Barbarash OL. Optimization of a Comprehensive Prehabilitation Program for Patients with Stable Coronary Artery Disease Undergoing Elective Coronary Artery Bypass Grafting. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-08-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To evaluate the effectiveness of a comprehensive prehabilitation program including the optimization of drug therapy for patients undergoing elective coronary artery bypass grafting (CABG).Material and methods. 56 male patients with stable angina referred to elective on-pump CABG were enrolled in a study. All patients were screened for eligibility according to the inclusion/exclusion criteria and then randomized into two groups. Group 1 patients (n=28) underwent preoperative management (prehabilitation) for 14 days, including patient education and physical rehabilitation. Trimetazidine in a dose of 80 mg per day was added to the standard drug therapy. Group 2 patients (n=28) underwent similar preoperative management, but with the standard drug therapy without trimetazidine. In addition to the routine methods of preoperative management, all patients underwent the 6-minute walk test (6MWT) to assess exercise tolerance and speckle tracking echocardiography to measure left ventricular (LV) longitudinal deformation. Serum troponin T was measured in all patients. The measurements were performed at admission and after the surgery.Results. Patients did not differ in the main clinical and demographic data, as well as the main preoperative speckle tracking echocardiography findings. The intraoperative parameters were comparable in both groups. The rate of early postoperative complications was 61% (n=17) in Group 1 and 64% (n=18) in Group 2 (p>0.05). LV ejection fraction significantly decreased postoperatively in both groups (p<0.01) as well as LV longitudinal deformation as compared to the baseline. Patients receiving the standard therapy without trimetazidine reported a significant decrease in the longitudinal strain after CABG compared with the baseline (p=0.01). There were no statistically significant differences in most preoperative and postoperative indicators of longitudinal deformation among patients treated with trimetazidine. Postoperative values of GLPS-LAX and GLPS-Avg were significantly higher in the trimetazidine group than those in the control group (p=0.04). Group 1 patients reported longer distance covered in 6MWT than Group 2 patients while assessing exercise tolerance: 370.0 [260.0;415.0] vs 242.0 [202.0;350.0] m, respectively (p=0.0059).Conclusion. The addition of trimetazidine in a dose of 80 mg daily in the prehabilitation program for patients undergoing elective CABG demonstrated better postoperative indicators of LV longitudinal deformation and an increase in exercise tolerance. Obtained findings allowed considering this approach to the preoperative management as an additional method of cardiac protection and optimization of the functional status of patients.
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Affiliation(s)
- Yu. A. Argunova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - T. N. Zvereva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - S. A. Pomeshkina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - A. V. Ivanova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. M. Polikutina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. V. Gruzdeva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - V. V. Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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85
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Ribeiro F, Santos M. [Exercise-based cardiac rehabilitation in COVID-19 times: one small step for health care systems, one giant leap for patients]. Rev Esp Cardiol 2020; 73:969-970. [PMID: 32904435 PMCID: PMC7455143 DOI: 10.1016/j.recesp.2020.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Fernando Ribeiro
- Institute of Biomedicine - iBiMED, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Mário Santos
- Department of Cardiology, Hospital Santo António, Centro Hospitalar Universitário do Porto, Oporto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Oporto, Portugal
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86
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Essential elements of anaesthesia practice in ERAS programs. World J Urol 2020; 40:1299-1309. [PMID: 32839862 DOI: 10.1007/s00345-020-03410-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Enhanced recovery pathways vary amongst institutions but include key components for anesthesiologists, such as haemodynamic optimization, use of short-acting drugs (and monitoring), postoperative nausea and vomiting (PONV) prophylaxis, protective ventilation, and opioid-sparing multimodal analgesia. METHODS After critical appraisal of the literature, studies were selected with particular attention being paid to meta-analyses, randomized controlled trials, and large prospective cohort studies. For each item of the perioperative treatment pathway, available English literature was examined and reviewed. RESULTS Patients should be permitted to drink clear fluids up to 2 h before anaesthesia and surgery. Oral carbohydrate loading should be used routinely. All patients may have an individualized plan for fluid and haemodynamic management that matches the monitoring needs with patient and surgical risk. Minimizing the side effects of anaesthetics and analgesics using short-acting drugs with careful perioperative monitoring should be encouraged. Protective ventilation with alveolar recruitment maneuvers is required. Preventive use of a combination with 2-3 antiemetics in addition to propofol-based total intravenous anaesthesia (TIVA) is most likely to reduce PONV. While the ideal analgesia regimen remains to be determined, it is clear that a multimodal opioid-sparing analgesic strategy has significant benefits. CONCLUSION Careful evaluation of single patient and planning of the anesthetic care are mandatory to join the ERAS philosophy. Optimal fluid management, use of short-acting drugs, prevention of PONV, protective ventilation, and multimodal analgesia are the cornerstones of the anaesthesia management within ERAS protocols.
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87
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Exercise-based cardiac rehabilitation in COVID-19 times: one small step for health care systems, one giant leap for patients. ACTA ACUST UNITED AC 2020; 73:969-970. [PMID: 32807711 PMCID: PMC7428457 DOI: 10.1016/j.rec.2020.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/24/2020] [Indexed: 02/08/2023]
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88
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Mora López L, Pallisera Llovera A, Serra-Aracil X, Serra Pla S, Lucas Guerrero V, Rebasa P, Tremps Domínguez C, Pujol Caballé G, Martínez Castela R, Subirana Giménez L, Martínez Cabañero J, Del Pino Zurita C, Agudo Arcos C, Carol Boeris FG, Navarro Soto S. A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery. Cir Esp 2020; 98:605-611. [PMID: 32430159 DOI: 10.1016/j.ciresp.2020.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A trimodal prehabilitation protocol was designed with the aim to evaluate whether it contributes to reducing postoperative morbidity, to evaluate the effect of prehabilitation on overall hospital stay, and to analyze the evolution of functional capacity before and after surgery. METHODS A single-center observational study of patients with colorectal cancer who underwent surgery with curative intent after a trimodal prehabilitation protocol. We collected data for postoperative morbidity according to the Comprehensive Complication Index and hospital stay, which were compared with a historical matrix. Functional capacity data were also collected before and after the application of the prehabilitation protocol. RESULTS Compared to the historical population, the overall Comprehensive Complication Index was reduced from 13.2 to 11.5, which was statistically significant. Analyzed by morbidity type, all decreased in percentage, although without achieving significance (surgical site infection from 11.7% to 8.4%, nosocomial infection 15.8 to 10% and medical morbidity 8.6% to 4.2%). The overall hospital stay went from 6 to 4 days, and the decrease in the percentage of patients who prepared at home was statistically significant in both cases. CONCLUSIONS Trimodal prehabilitation can contribute to lowering the postoperative morbidity and overall hospital stay of patients undergoing colorectal cancer surgery.
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Affiliation(s)
- L Mora López
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España.
| | - A Pallisera Llovera
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - X Serra-Aracil
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - S Serra Pla
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - V Lucas Guerrero
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - P Rebasa
- Unidad de Esofagogastroesofágica, Servicio de Cirugía, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - C Tremps Domínguez
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - G Pujol Caballé
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - R Martínez Castela
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - L Subirana Giménez
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - J Martínez Cabañero
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - C Del Pino Zurita
- Enfermería Grupo Rehabilitación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - C Agudo Arcos
- Enfermería Grupo Rehabilitación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - F G Carol Boeris
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - S Navarro Soto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
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89
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Beck A, Thaysen HV, Soegaard CH, Blaakaer J, Seibaek L. Investigating the experiences, thoughts, and feelings underlying and influencing prehabilitation among cancer patients: a qualitative perspective on the what, when, where, who, and why. Disabil Rehabil 2020; 44:202-209. [PMID: 32400218 DOI: 10.1080/09638288.2020.1762770] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: To investigate the experiences, thoughts, and feelings that underlie and influence prehabilitation among cancer patients due to undergo major abdominal surgery.Materials and methods: Prior to their surgery, sixteen patients with peritoneal carcinomatosis of colorectal or ovarian origin due to undergo major surgery received oral information and a leaflet with preoperative recommendations. They subsequently participated in individual, semi-structured interviews. Malterud's principles of systematic text condensation were used to analyse the interviews, and the concept of action competence inspired and framed the discussion.Results: Although the patients found themselves in an unpredictable and uncontrollable situation, they nevertheless knew what was important to them. These factors were contextualised in five themes that reflected the experiences, thoughts, and feelings that underlay and influenced their actions: "Perception of preparation," "The two-sided preoperative period," "Home or facility-based prehabilitation," "Stakeholders in prehabilitation," and "Reasons for taking action".Conclusions: The patients demonstrated action competence in relation to their preoperative preparation. However, in relation to the kind of prehabilitation that required lifestyle changes, their action competence needed to be developed and supported. To do so, it is necessary to ask questions that cover the patients' perspectives of the what, when, where, who, and why of prehabilitation.IMPLICATIONS FOR REHABILITATIONPatients undergoing major, abdominal cancer surgery have very clear opinions about what are important to them during the preoperative period, and this is not only limited to prehabilitation-related actions.In order to develop patients' action competence in relation to prehabilitation, patients need more support and supervision from health professionals.Qualitative in-depth knowledge concerning the what, when, where, who, and why of prehabilitation should be taken into account in the development of future prehabilitation programmes.
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Affiliation(s)
- Anne Beck
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
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90
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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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91
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Barberan-Garcia A, Navarro-Ripoll R, Sánchez-Lorente D, Moisés-Lafuente J, Boada M, Messaggi-Sartor M, González-Vallespí L, Montané-Muntané M, Alsina-Restoy X, Campero B, Lopez-Baamonde M, Romano-Andrioni B, Guzmán R, López A, Arguis MJ, Roca J, Martinez-Palli G. Cost-effectiveness of a technology-supported multimodal prehabilitation program in moderate-to-high risk patients undergoing lung cancer resection: randomized controlled trial protocol. BMC Health Serv Res 2020; 20:207. [PMID: 32164687 PMCID: PMC7068871 DOI: 10.1186/s12913-020-05078-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background Multimodal prehabilitation is a preoperative intervention with the objective to enhance cancer patients’ functional status which has been showed to reduce both postoperative morbidity and hospital length of stay in digestive oncologic surgery. However, in lung cancer surgery patients further studies with higher methodological quality are needed to clarify the benefits of prehabilitation. The main aim of the current protocol is to evaluate the cost-effectiveness of a multimodal prehabilitation program supported by information and communication technologies in moderate-to-high risk lung cancer patients undergoing thoracic surgery. Methods A Quadruple Aim approach will be adopted, assessing the prehabilitation program at the following levels: i) Patients’ and professionals’ experience outcomes (by means of standardized questionnaires, focus groups and structured interviews); ii) Population health-based outcomes (e.g. hospital length of stay, number and severity of postoperative complications, peak oxygen uptake and levels of systemic inflammation); and, iii) Healthcare costs. Discussion This study protocol should contribute not only to increase the scientific basis on prehabilitation but also to detect the main factors modulating service adoption. Trial registration NCT04052100 (August 9, 2019).
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Affiliation(s)
- Anael Barberan-Garcia
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain. .,Biomedical Networking Research Centre on Respiratory Diseases (CIBERES), Barcelona, Spain.
| | - Ricard Navarro-Ripoll
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Jorge Moisés-Lafuente
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Marc Boada
- Thoracic Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Monique Messaggi-Sartor
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain
| | | | - Mar Montané-Muntané
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Alsina-Restoy
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Betina Campero
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Lopez-Baamonde
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Rudith Guzmán
- Thoracic Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonio López
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Jose Arguis
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Roca
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain.,Biomedical Networking Research Centre on Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Graciela Martinez-Palli
- August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain.,Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
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92
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Beck A, Vind Thaysen H, Hasselholt Soegaard C, Blaakaer J, Seibaek L. Prehabilitation in cancer care: patients' ability to prepare for major abdominal surgery. Scand J Caring Sci 2020; 35:143-155. [PMID: 32043644 DOI: 10.1111/scs.12828] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/21/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients' perspectives on standardised, multimodal prehabilitation programmes showed barriers to adherence. Further investigation of patients' ability to prepare is needed. AIM To investigate what patients with cancer who were due to undergo major abdominal surgery actually were able to do when provided with preoperative, home-based, multimodal recommendations presented in a leaflet. METHODS Patients from the colorectal- or ovarian cancer centre, who were scheduled for major abdominal surgery, received a leaflet with preoperative recommendations. On a daily basis, the patients filled in what they had completed in relation to these recommendations, so that adherence could be investigated. Additionally, face-to-face interviews were conducted to evaluate patients' experiences of using the leaflet. Malterud's principles of systematic text condensation were used to analyse the interviews. A convergent design was used to merge the quantitative and qualitative data into a combined interpretation presented in the discussion. RESULTS A total of 53 patients returned a completed leaflet, and five patients were interviewed. In the combined interpretation, patients' ability to prepare was presented through four major domains. The domains were adherence and the importance of support, manageable actions leading to change, preparation in a broader perspective and impediments to preparation and to symptom relief. CONCLUSIONS Patients prepared themselves in various ways, which were not limited to recommendations inspired by multimodal prehabilitation. Patients from the ovarian cancer centre increased their weekly exercise during the preoperative period, which indicates that the leaflet not only functioned as a data collection tool, but also motivated and supported the patients in prehabilitation-related actions. Patients' perspectives on prehabilitation need to be taken into account, when aiming to enhance patient-centredness and adherence.
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Affiliation(s)
- Anne Beck
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
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93
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Fonteyne V, Rammant E, Decaestecker K. Predicting perioperative mortality after radical cystectomy: comorbidity assessment tools are only part of the puzzle. Transl Androl Urol 2020; 8:781-784. [PMID: 32038980 DOI: 10.21037/tau.2019.07.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Valérie Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
| | - Elke Rammant
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
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94
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Nilsson U, Gruen R, Myles PS. Postoperative recovery: the importance of the team. Anaesthesia 2020; 75 Suppl 1:e158-e164. [DOI: 10.1111/anae.14869] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 12/17/2022]
Affiliation(s)
- U. Nilsson
- Division of Nursing Department of Neurobiology, Care Sciences and Society Karolinska Institute and Peri‐operative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - R. Gruen
- College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - P. S. Myles
- Department of Anaesthesiology and Peri‐operative Medicine Alfred Hospital and Monash University Melbourne Vic. Australia
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95
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Levy N, Grocott MPW, Lobo DN. Restoration of function: the holy grail of peri-operative care. Anaesthesia 2020; 75 Suppl 1:e14-e17. [PMID: 31903580 DOI: 10.1111/anae.14893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | - M P W Grocott
- Anaesthesia and Critical Care Medicine, Southampton National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust / University of Southampton, Southampton, UK
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- David Greenfield Human Physiology Unit,MRCVersus Arthritis Centre for Musculoskeletal Ageing, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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96
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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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97
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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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98
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McDonald S, Yates D, Durrand JW, Kothmann E, Sniehotta FF, Habgood A, Colling K, Hollingsworth A, Danjoux G. Exploring patient attitudes to behaviour change before surgery to reduce peri-operative risk: preferences for short- vs. long-term behaviour change. Anaesthesia 2019; 74:1580-1588. [PMID: 31637700 DOI: 10.1111/anae.14826] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/13/2023]
Abstract
Pre-operative intervention to improve general health and readiness for surgery is known as prehabilitation. Modification of risk factors such as physical inactivity, smoking, hazardous alcohol consumption and an unhealthy weight can reduce the risk of peri-operative morbidity and improve patient outcomes. Interventions may need to target multiple risk behaviours. The acceptability to patients is unclear. We explored motivation, confidence and priority for changing health behaviours before surgery for short-term peri-operative health benefits in comparison with long-term general health benefits. A total of 299 participants at three UK hospital Trusts completed a structured questionnaire. We analysed participant baseline characteristics and risk behaviour profiles using independent sample t-tests and odds ratios. Ratings of motivation, confidence and priority were analysed using paired sample t-tests. We identified a substantial prevalence of risk behaviours in this surgical population, and clustering of multiple behaviours in 42.1% of participants. Levels of motivation, confidence and priority for increasing physical activity, weight management and reducing alcohol consumption were higher for peri-operative vs. longer term benefits. There was no difference for smoking cessation, and participants reported lower confidence for achieving this compared with other behaviours. Participants were also more confident than motivated in reducing their alcohol consumption pre-operatively. Overall, confidence ratings were lower than motivation levels in both the short- and long-term. This study identifies both substantial patient desire to modify behaviours for peri-operative benefit and the need for structured pre-operative support. These results provide objective evidence in support of a 'pre-operative teachable moment', and of patients' desire to change behaviours for health benefits in the short term.
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Affiliation(s)
- S McDonald
- The Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - D Yates
- Department of Anaesthesia, York Teaching Hospitals NHS Foundation Trust, York, UK
| | - J W Durrand
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - E Kothmann
- Department of Anaesthesia, University Hospitals of North Tees and Hartlepool, Stockton-on-Tees, UK
| | - F F Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - A Habgood
- Department of Anaesthesia, Northumbria Healthcare NHS Foundation Trust, Northern Deanery, UK
| | - K Colling
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - A Hollingsworth
- Academic Department of Military Surgery & Trauma, Royal Center for Defence Medicine, Birmingham, UK
| | - G Danjoux
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
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99
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Engel D, Furrer MA, Wuethrich PY, Löffel LM. Surgical safety in radical cystectomy: the anesthetist's point of view-how to make a safe procedure safer. World J Urol 2019; 38:1359-1368. [PMID: 31201522 DOI: 10.1007/s00345-019-02839-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this review is to present an anesthesiological overview on surgical safety for radical cystectomy implementing the cornerstones of today's rapidly evolving field of perioperative medicine. METHODS This is a narrative review of current perioperative medicine and surgical safety concepts for major surgery in general with special focus on radical cystectomy. RESULTS The tendency for perioperative care and surgical safety is to consider it a continuous proactive pathway rather than a single surgical intervention. It starts at indication for surgery and lasts until full functional recovery. Preoperative optimization leads to superior outcome by mobilizing and/or increasing physiological reserve. Multidisciplinary teamwork involving all the relevant parties from the beginning of the pathway is crucial for outcome rather than an isolated specialist approach. This fact has gained importance in times of an ageing frail population and rising health care cost. We also present our 2019 Cystectomy Enhanced Recovery Approach for optimization of perioperative care for open radical cystectomy in a high caseload center. CONCLUSIONS With the implementation of in itself simple but crucial steps in perioperative medicine such as multimodal prehabilitation, safety checks, better perioperative monitoring and enhanced recovery concepts, even complex surgical procedures such as radical cystectomy can be performed safer. Emphasis has to be laid on a more global view of the patients' path through the perioperative process than on the surgical procedure alone.
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Affiliation(s)
- Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, CH 3010, Bern, Switzerland
| | - Marc A Furrer
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, CH 3010, Bern, Switzerland
| | - Lukas M Löffel
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, CH 3010, Bern, Switzerland.
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O. Bechstein W, A. Schnitzbauer A. Operative Procedures: New Ways of Managing Frailty. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:61-62. [PMID: 30950383 PMCID: PMC6444032 DOI: 10.3238/arztebl.2019.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Wolf O. Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt
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