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Kovoor JG, Nann SD, Chambers C, Mishra K, Goel S, Thompson I, Koh D, Litwin P, Bacchi S, Harford PJ, Stretton B, Gupta AK. Prehabilitation before general surgery: Worth the effort? J Perioper Pract 2024; 34:219-225. [PMID: 38149496 DOI: 10.1177/17504589231214395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Prehabilitation, or interventions before surgery aimed at improving preoperative health and postoperative outcomes, has various forms. Although it may confer benefit to patients undergoing general surgery, this is not certain. Furthermore, although it may yield a net monetary gain, it is also likely to require substantial monetary and non-monetary investment. The impact of prehabilitation is highly variable and dependent on multiple factors. Physical function and pulmonary outcomes are likely to be improved by most forms of prehabilitation involving physical and multimodal exercise programmes. However, other surgical outcomes have demonstrated mixed results from prehabilitation. Within this issue, the measures used for evaluating baseline patient biopsychosocial health are important, and collecting sufficient data to accurately inform patient-centred prehabilitation programmes is only possible through thorough clinical and laboratory investigation and synthesised metrics such as cardiopulmonary exercise testing. Although a multimodal approach to prehabilitation is the current gold standard, societal factors may affect engagement with programmes that require a significant in-person activity. However, this is weighed against the substantial financial and non-financial investment that accompanies many programmes. The overall effectiveness and optimal mode of intervention across the discipline of general surgery remains unclear, and further research is needed to prove prehabilitation's full worth.
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Affiliation(s)
- Joshua G Kovoor
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Silas D Nann
- Health and Information, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Courtney Chambers
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kritika Mishra
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sahil Goel
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Isabella Thompson
- Gold Coast University Hospital, Gold Coast, QLD, Australia
- Bond University, Gold Coast, QLD, Australia
| | - Dong Koh
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter Litwin
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Stephen Bacchi
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Philip J Harford
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Brandon Stretton
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Aashray K Gupta
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
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Vu J, Koh C, Solomon M, Brown K, Karunaratne S, Cole R, Smith P, Raichurkar P, Denehy L, Riedel B, Steffens D. Patients' and carers' views on research priorities in prehabilitation for cancer surgery. Support Care Cancer 2024; 32:378. [PMID: 38787478 PMCID: PMC11126464 DOI: 10.1007/s00520-024-08585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The views of patients and carers are important for the development of research priorities. This study aimed to determine and compare the top research priorities of cancer patients and carers with those of multidisciplinary clinicians with expertise in prehabilitation. MATERIALS AND METHODS This cross-sectional study surveyed patients recovering from cancer surgery at a major tertiary hospital in Sydney, Australia, and/or their carers between March and July 2023. Consenting patients and carers were provided a list of research priorities according to clinicians with expertise in prehabilitation, as determined in a recent International Delphi study. Participants were asked to rate the importance of each research priority using a 5-item Likert scale (ranging from 1 = very high research priority to 5 = very low research priority). RESULTS A total of 101 patients and 50 carers participated in this study. Four areas were identified as research priorities, achieving consensus of highest importance (> 70% rated as "high" or "very high" priority) by patients, carers, and clinical experts. These were "optimal composition of prehabilitation programs" (77% vs. 82% vs. 88%), "effect of prehabilitation on surgical outcomes" (85% vs. 90% vs. 95%), "effect of prehabilitation on functional outcomes" (83% vs. 86% vs. 79%), and "effect of prehabilitation on patient reported outcomes" (78% vs. 84% vs. 79%). Priorities that did not reach consensus of high importance by patients despite reaching consensus of highest importance by experts included "identifying populations most likely to benefit from prehabilitation" (70% vs. 76% vs. 90%) and "defining prehabilitation core outcome measures" (66% vs. 74% vs. 87%). "Prehabilitation during neoadjuvant therapies" reached consensus of high importance by patients but not by experts or carers (81% vs. 68% vs. 69%). CONCLUSION This study delineated the primary prehabilitation research priorities as determined by patients and carers, against those previously identified by clinicians with expertise in prehabilitation. It is recommended that subsequent high-quality research and resource allocation be directed towards these highlighted areas of importance.
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Affiliation(s)
- Jennifer Vu
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Kilian Brown
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Ruby Cole
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
| | - Phillippa Smith
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
| | - Pratik Raichurkar
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Bernhard Riedel
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Missenden Road, PO Box M157, Sydney, NSW, 2050, Australia.
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, Australia.
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Pufulete M, Coyle V, Provan D, Shaw C, Kunzmann P, Bowrey DJ, Barlow R, Grocott MPW, Shah T, Atkinson C. Prehabilitation provision and practice in the UK: a freedom of information survey. Br J Anaesth 2024; 132:815-819. [PMID: 38326209 DOI: 10.1016/j.bja.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- Maria Pufulete
- Bristol Heart Institute, University of Bristol, Bristol, UK; National Institute for Health and Care Research (NIHR), Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trusts/Boards and University of Bristol, Bristol, UK.
| | - Vicky Coyle
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Debbie Provan
- Cancer and Rehabilitation Unit, Scottish Government, NHS Ayrshire and Arran, Glasgow, UK
| | - Clare Shaw
- NIHR Biomedical Research Centre, The Royal Marsden and Institute of Cancer Research, London, UK
| | - Peter Kunzmann
- Policy and Public Affairs, Royal College of Anaesthetists, London, UK
| | - David J Bowrey
- Department of Surgery, University Hospitals of Leicester NHS Trusts/Boards, Leicester, UK
| | - Rachael Barlow
- Cardiff and Vale University Health Board and Swansea Bay University Health Board, Cardiff, NHS Wales, UK
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| | - Toral Shah
- NIHR Cancer and Nutrition Collaboration, Southampton, UK
| | - Charlotte Atkinson
- National Institute for Health and Care Research (NIHR), Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trusts/Boards and University of Bristol, Bristol, UK
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Kehlet H, Lobo DN. Exploring the need for reconsideration of trial design in perioperative outcomes research: a narrative review. EClinicalMedicine 2024; 70:102510. [PMID: 38444430 PMCID: PMC10912044 DOI: 10.1016/j.eclinm.2024.102510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
"Enhanced recovery after surgery" is a multimodal effort to control perioperative pathophysiology and improve outcome. However, despite advances in perioperative care, postoperative complications and the need for hospitalisation and prolonged recovery continue to be challenging. This is further complicated by procedure-specific and patient-associated risk factors, given the increase in the number of elderly and frail patients with multiple comorbidities undergoing surgery. This paper is a critical assessment of current methodology for trials in perioperative medicine. We make a plea to reconsider the design of future interventional trials to improve surgical outcome, based upon studies of potentially effective interventions, but often without improvements in recovery. The complexity of perioperative pathophysiology necessitates a procedure- and patient-specific approach whenever outcome is assessed or interventions are planned. With improved understanding of perioperative pathophysiology, the way to improve outcomes looks promising, provided that knowledge and established enhanced recovery programmes are integrated in trial design. Funding None.
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Affiliation(s)
- Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dileep N. Lobo
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Skořepa P, Ford KL, Alsuwaylihi A, O'Connor D, Prado CM, Gomez D, Lobo DN. The impact of prehabilitation on outcomes in frail and high-risk patients undergoing major abdominal surgery: A systematic review and meta-analysis. Clin Nutr 2024; 43:629-648. [PMID: 38306891 DOI: 10.1016/j.clnu.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND & AIMS Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes. The aim of this systematic review and meta-analysis was to determine the impact of prehabilitation on postoperative outcomes in frail and high-risk patients undergoing major abdominal surgery. METHODS Embase, Medline, CINAHAL and Cochrane databases were searched from January 2010 to January 2023 for randomised clinical trials (RCTs) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes. Meta-analysis was limited to length of stay (primary end point), severe postoperative complications (Clavien-Dindo Classification ≥ Grade 3) and the 6-minute walk test (6MWT). The analysis was performed using RevMan v5.4 software. RESULTS Sixteen studies (6 RCTs, 10 observational) reporting on 3339 patients (1468 prehabilitation group, 1871 control group) were included. The median (interquartile range) age was 74.0 (71.0-78.4) years. Multimodal prehabilitation was applied in fifteen studies and unimodal in one. Meta-analysis of nine studies showed a reduction in hospital length of stay (weighted mean difference -1.07 days, 95 % CI -1.60 to -0.53 days, P < 0.0001, I2 = 19 %). Ten studies addressed severe complications and a meta-analysis suggested a decline in occurrence by up to 44 % (odds ratio 0.56, 95 % CI 0.37 to 0.82, P < 0.004, I2 = 51 %). Four studies provided data on preoperative 6MWT. The pooled weighted mean difference was 40.1 m (95 % CI 32.7 to 47.6 m, P < 0.00001, I2 = 24 %), favouring prehabilitation. CONCLUSION Given the significant impact on shortening length of stay and reducing severe complications, prehabilitation should be encouraged in frail, older and high-risk adult patients undergoing major abdominal surgery.
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Affiliation(s)
- Pavel Skořepa
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic; 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic. https://twitter.com/PavelSkorepa
| | - Katherine L Ford
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada; Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Canada. https://twitter.com/KathFord_RD
| | - Abdulaziz Alsuwaylihi
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dominic O'Connor
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK. https://twitter.com/Dom_OConnor1
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada. https://twitter.com/DrCarlaPrado
| | - Dhanny Gomez
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Brown LA, Griffiths JA, Santer P, Jakeman PM, Smith TG. Potential for using simulated altitude as a means of prehabilitation: a physiology study. Anaesthesia 2023; 78:1472-1480. [PMID: 37877784 PMCID: PMC10953332 DOI: 10.1111/anae.16158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
The current pandemic of surgical complications necessitates urgent and pragmatic innovation to reduce postoperative morbidity and mortality, which are associated with poor pre-operative fitness and anaemia. Exercise prehabilitation is a compelling strategy, but it has proven difficult to establish that it improves outcomes either in isolation or as part of a multimodal approach. Simulated altitude exposure improves performance in athletes and offers a novel potential means of improving cardiorespiratory and metabolic fitness and alleviating anaemia within the prehabilitation window. We aimed to provide an initial physiological foundation for 'altitude prehabilitation' by determining the physiological effects of one week of simulated altitude (FI O2 15%, equivalent to approximately 2438 m (8000 ft)) in older sedentary volunteers. The study used a randomised, double-blind, sham-controlled crossover design. Eight participants spent counterbalanced normoxic and hypoxic weeks in a residential hypoxia facility and underwent repeated cardiopulmonary exercise tests. Mean (SD) age of participants was 64 (7) y and they were unfit, with mean (SD) baseline anaerobic threshold 12 (2) ml.kg-1 .min-1 and mean (SD) peak V̇O2 15 (3) ml.kg-1 .min-1 . Hypoxia was mild (mean (SD) Sp O2 93 (2) %, p < 0.001) and well-tolerated. Despite some indication of greater peak exercise capacity following hypoxia, overall there was no effect of simulated altitude on anaerobic threshold or peak V̇O2 . However, hypoxia induced a substantial increase in mean (SD) haemoglobin of 1.5 (2.7) g.dl-1 (13% increase, p = 0.028). This study has established the concept and feasibility of 'altitude prehabilitation' and demonstrated specific potential for improving haematological fitness. Physiologically, there is value in exploring a possible role for simulated altitude in pre-operative optimisation.
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Affiliation(s)
| | - J. A. Griffiths
- Nuffield Department of AnaesthesiaOxford University Hospitals NHS Foundation TrustOxfordUK
| | - P. Santer
- Department of Anesthesia, Critical Care and Pain MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMAUSA
| | - P. M. Jakeman
- Health Research Institute and Department of Physical Education and Sport SciencesUniversity of LimerickLimerickIreland
| | - T. G. Smith
- Centre for Human and Applied Physiological SciencesKing's College LondonLondonUK
- Department of AnaesthesiaGuy's and St Thomas' NHS Foundation TrustLondonUK
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7
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Jandu AK, Nitayamekin A, Stevenson J, Beed M, Vohra RS, Wilson VG, Lobo DN. Post-Cancer Treatment Reflections by Patients Concerning the Provisions and Support Required for a Prehabilitation Programme. World J Surg 2023; 47:2724-2732. [PMID: 37698631 PMCID: PMC10545643 DOI: 10.1007/s00268-023-07170-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Evidence suggests that physical fitness interventions, mental health support and nutritional advice before surgery (prehabilitation) could reduce hospital stay and improve quality of life of patients with cancer. In this study we captured the opinions of a group of patients with cancer undergoing these interventions after treatment to discover what a prehabilitation programme should encompass. METHODS Patients from the Cancer and Rehabilitation Exercise (CARE) programme based in Nottingham took part in a 26-point online questionnaire about the design of prehabilitation programmes. RESULTS The questionnaire was completed over a 2-week period in December 2021 by 54 patients from the CARE programme. Their responses were as follows: 44 (81.5%) participants would have participated in prehabilitation had it been available to them and 28 (51.9%) ranked physical exercise as the most important component. Forty (74.1%) participants believed the counselling aspect of prehabilitation would have contributed to a successful outcome and 35 (64.8%) thought dietary advice would have benefitted them before surgery. Thirty-one (57.4%) participants preferred the programme to take place in a fitness centre, rather than at home or hospital and 43 (79.6%) would have liked to have known about prehabilitation from their doctor at the time of diagnosis. CONCLUSIONS Patients are interested in prehabilitation to become more physically fit and mentally prepared for surgery. They expressed the need for a focus on physical exercise, counselling to improve mental health and personalised nutritional advice. Tailoring a prehabilitation programme, with input from patients, could contribute to improving patient outcomes following cancer treatments.
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Affiliation(s)
- Amrita Kaur Jandu
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Arpanun Nitayamekin
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Josh Stevenson
- The Notts County Foundation CARE Programme, Portland Leisure Centre, Nottingham, UK
| | - Martin Beed
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Ravinder S Vohra
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Vincent G Wilson
- School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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van Zundert A, Gatt SP, van Zundert TC. Prevention and treatment of noncognitive complications. Saudi J Anaesth 2023; 17:557-565. [PMID: 37779568 PMCID: PMC10540984 DOI: 10.4103/sja.sja_329_23] [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: 04/22/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 10/03/2023] Open
Abstract
Patients aged 65 and older are the fastest growing segment in the population of many countries. Based on evolving demographics showing increasing life expectancies, it is expected that there will be a concurrent rise in the demand for a large variety of surgical and anesthesia services. Surgery offers definitive management of many age-related diseases and provides symptom-relieving (morbidity) and life-extending (mortality) benefits. However, elderly adult surgical patients, especially the frail ones, often require a different level of care than younger patients during the perioperative period. As many have chronic illnesses and acquired deconditioning and functional decline, older patients are prone to develop untoward outcomes such as postoperative complications and loss of independence. This manuscript focuses on the holistic quality person-centered care, supported by a wide stakeholder team of health-care workers, ensuring fidelity to comprehensive geriatric assessment and optimization services where possible, offering a systematic approach to early health risk assessment and risk modification in the perioperative period, with the ultimate goal of reducing postoperative complications and health-care costs. The "comprehensive geriatric assessment and optimization" cost-effective approach builds on robust evidence with older people more likely to be alive, a shorter length of hospital stay due to fewer postoperative medical complications, and improved rates of return to usual residence. Prehabilitation programs are delivered focusing on primary (through counseling) and secondary prevention (through screening) with an aim to improve fitness for surgery, by evaluating functional capacity, nutritional and psychological health, prompting interventions, targeting physical exercise, lifestyle and nutritional advice, and psychological support.
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Affiliation(s)
- André van Zundert
- The Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Stephen P. Gatt
- Department of Anaesthesia, The University of New South Wales, Sydney, NSW, Australia and Udayana University, Indonesia
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Banasiewicz T, Kobiela J, Cwaliński J, Spychalski P, Przybylska P, Kornacka K, Bogdanowska-Charkiewicz D, Leyk-Kolańczak M, Borejsza-Wysocki M, Batycka-Stachnik D, Drwiła R. Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery. POLISH JOURNAL OF SURGERY 2023; 95:62-91. [PMID: 38348849 DOI: 10.5604/01.3001.0053.8854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Jarosław Kobiela
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Spychalski
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Patrycja Przybylska
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Karolina Kornacka
- Oddział Chirurgii Ogólnej, Onkologicznej i Kolorektalnej, Wielospecjalistyczny Szpital Miejski im. J. Strusia, Poznań
| | | | - Magdalena Leyk-Kolańczak
- Zakład Pielęgniarstwa Chirurgicznego, Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Maciej Borejsza-Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Dominika Batycka-Stachnik
- Oddział Kliniczny Chirurgii Serca, Naczyń i Transplantologii, Krakowski Szpital Specjalistyczny im. Św. Jana Pawła II, Kraków
| | - Rafał Drwiła
- Katedra i Zakład Anestezjologii i Intensywnej Terapii, Collegium Medicum Uniwersytet Jagielloński, Kraków
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Cappe M, Laterre PF, Dechamps M. Preoperative frailty screening, assessment and management. Curr Opin Anaesthesiol 2023; 36:83-88. [PMID: 36476726 PMCID: PMC9794163 DOI: 10.1097/aco.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To highlight the importance of frailty assessment in thoracic surgery patients. RECENT FINDINGS Frailty results from an accelerated loss of functional reserve associated with ageing and leads to increased vulnerability following surgery. It is a complex and multidimensional syndrome involving physiological and psychosocial systems. Frailty is a separate entity from comorbidities and disabilities. Frailty is associated with an increased risk of complications and a higher mortality rate after thoracic surgery. Patients can easily be screened for frailty and frail patients can benefit from further assessment of all areas of frailty secondarily. Prehabilitation and rehabilitation can help limit frailty-related complications after thoracic surgery. SUMMARY Frailty should be part of the routine preoperative evaluation for thoracic surgery. Frailty must be considered in assessing eligibility for surgery and in planning prehabilitation and rehabilitation if necessary.
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Affiliation(s)
- Maximilien Cappe
- Department of Cardiovascular Anesthesiology, University Hospital Saint-Luc, Université Catholique de Louvain (UCLouvain)
| | - Pierre-François Laterre
- Critical Care Coordinating Center (4Cs), Brussels
- Department of Intensive Care, Centre Hospitalier Régional Mons-Hainaut, Mons
| | - Mélanie Dechamps
- Critical Care Coordinating Center (4Cs), Brussels
- Department of Cardiovascular Intensive Care, University Hospital Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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