1
|
Cuijpers ACM, Lubbers T, Dronkers JJ, Heldens AFJM, Zoethout SB, Leistra D, van Kuijk SMJ, van Meeteren NLU, Stassen LPS, Bongers BC. Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108338. [PMID: 38728861 DOI: 10.1016/j.ejso.2024.108338] [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] [Received: 12/19/2023] [Revised: 03/01/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Preoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery. MATERIALS AND METHODS Models were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance. RESULTS Aerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598-0.733) and 0.722 (0.651-0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %). CONCLUSION Both models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.
Collapse
Affiliation(s)
- Anne C M Cuijpers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, GROW, Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Tim Lubbers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, GROW, Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Jaap J Dronkers
- Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Aniek F J M Heldens
- Department of Physical Therapy, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Siebrand B Zoethout
- Department of Physical Therapy, Deventer Hospital, Deventer, the Netherlands.
| | - Duncan Leistra
- Department of Physical Therapy, Nij Smellinghe Hospital, Drachten, the Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Nico L U van Meeteren
- Top Sector Life Sciences and Health (Health∼Holland), The Hague, the Netherlands; Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - Bart C Bongers
- Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| |
Collapse
|
2
|
Mizuno Y, Yokoyama Y, Nakajima H, Inoue T, Tanaka S, Nagaya M, Inokawa Y, Ando M, Nishida Y, Ebata T. The impact of goal-directed prehabilitation therapy on functional capacity in patients undergoing hepatobiliary and pancreatic surgery: A randomized clinical trial. Surgery 2024:S0039-6060(24)00272-1. [PMID: 38755033 DOI: 10.1016/j.surg.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Emerging evidence has supported the idea that goal-directed prehabilitation is a promising approach to boost functional capacity in preoperative patients. However, its usefulness has not been tested in the hepatobiliary and pancreatic fields. The objective of this trial was to investigate the efficacy of goal-directed prehabilitation for improving functional capacity in patients who were planned to undergo major hepatobiliary and pancreatic operations. METHODS This assessor-blinded, parallel-arm, randomized clinical trial recruited patients who were scheduled for major hepatobiliary and pancreatic surgeries for malignancy. Patients were randomly allocated into the step goal-directed prehabilitation group as the test group and into the conventional prehabilitation group as the control group. Patients in the goal-directed prehabilitation group participated in a walking prehabilitation program with an intergrading goal of the step count. Patients in the conventional prehabilitation group received standard physical and nutritional prehabilitation. The primary outcome was change in the 6-minute walking distance, which ranged from the time before starting prehabilitation (baseline) to the time after completing prehabilitation (immediately before surgery). RESULTS Among 180 randomized patients, 144 patients were included in the primary analysis (73 patients in the conventional prehabilitation group and 71 patients in the goal-directed prehabilitation group). The mean change in the 6-minute walking distance was 27 meters in the conventional prehabilitation group and 31 meters in the goal-directed prehabilitation group (P = .633). CONCLUSION In patients undergoing major hepatobiliary and pancreatic surgeries for malignancies, a goal-directed prehabilitation program did not result in a significantly greater increase in functional capacity than did conventional prehabilitation. REGISTRATION NUMBER UMIN000038791 (https://www.umin.ac.jp/).
Collapse
Affiliation(s)
- Yota Mizuno
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hiroki Nakajima
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Inoue
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Motoki Nagaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshikuni Inokawa
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
3
|
Trul-Kreuze IA, Akkerman M, Kieboom EAM, Nieuwenhuis MK, Houdijk H, Bongers BC. Clinimetric Properties of the Steep Ramp Test to Assess Cardiorespiratory Fitness, Its Underlying Physiological Responses, and Its Current Applications: A Scoping Review. Arch Phys Med Rehabil 2024:S0003-9993(24)00827-X. [PMID: 38412899 DOI: 10.1016/j.apmr.2024.02.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Providing an overview of the clinimetric properties of the steep ramp test (SRT)-a short-term maximal exercise test-to assess cardiorespiratory fitness (CRF), describing its underlying physiological responses, and summarizing its applications in current clinical and research practice. DATA SOURCES MEDLINE (through PubMed), CINAHL Complete, Cochrane Library, EMBASE, and PsycINFO were searched for studies published up to July 2023, using keywords for SRT and CRF. STUDY SELECTION Eligible studies involved the SRT as research subject or measurement instrument and were available as full text articles in English or Dutch. DATA EXTRACTION Two independent assessors performed data extraction. Data addressing clinimetric properties, physiological responses, and applications of the SRT were tabulated. DATA SYNTHESIS In total, 370 studies were found, of which 39 were included in this study. In several healthy and patient populations, correlation coefficients between the work rate at peak exercise (WRpeak) attained at the SRT and oxygen uptake at peak exercise during cardiopulmonary exercise testing (CPET) ranged from .771-.958 (criterion validity). Repeated measurements showed intraclass correlation coefficients ranging from .908-.996 for WRpeak attained with the first and second SRT (test-retest reliability). Physiological parameters, like heart rate and minute ventilation at peak exercise, indicated that the SRT puts a lower burden on the cardiopulmonary system compared to CPET. The SRT is mostly used to assess CRF, among others as part of preoperative risk assessment, and to personalize interval training intensity. CONCLUSIONS The SRT is a practical short-term maximal exercise test that is valid for CRF assessment and to monitor changes in CRF over time in various healthy and patient populations. Its clinimetric properties and potential applications make the SRT of interest for a widespread implementation of CRF assessment in clinical and research practice and for personalizing training intensity and monitoring longitudinal changes in CRF.
Collapse
Affiliation(s)
- Ingeborg A Trul-Kreuze
- Association of Dutch Burn Centers, Burn Center Groningen, Martini Hospital, Groningen; Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen; Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen
| | - Moniek Akkerman
- Association of Dutch Burn Centers, Burn Center Groningen, Martini Hospital, Groningen; Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen
| | - Eleonora A M Kieboom
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen
| | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Center Groningen, Martini Hospital, Groningen; Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen; Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen
| | - Han Houdijk
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen
| | - Bart C Bongers
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen; Department of Nutrition and Movement Sciences, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht; Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
4
|
Xu TQ, Maguire J, Gould J. The impact of frailty on outcomes following laparoscopic repair of 'giant' paraesophageal hernias. Surg Endosc 2023:10.1007/s00464-023-10163-1. [PMID: 37294432 DOI: 10.1007/s00464-023-10163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Frailty is a measure of physiologic reserve and correlates with surgical outcomes in the elderly. Patients who present with giant paraesophageal hernias (PEH) are typically older than 65. We defined 'giant' as a PEH with 50% or more of the stomach in the chest. We hypothesized that frailty correlates with 30-day complications, length of stay, and discharge destination following laparoscopic giant PEH repair. METHODS Patients older than 65 to undergo primary laparoscopic repair of a giant PEH at a single academic medical center between 2015 and 2022 were included. Hernia size was determined by preoperative imaging. Frailty was assessed clinically prior to surgery using the modified Frailty Index (mFI), an 11-item instrument that counts clinical deficits associated with frailty. A score ≥ 3 was considered frail. A major complication was a Clavien grade IIIB or higher. RESULTS Of the 162 patients included in the study, mean age was 74.4 ± 7.2, and 66% of patients were female (n = 128). The mFI was ≥ 3 in 37 patients (22.8%). Frail patients were older (78 ± 7.9 vs. 73 ± 6.6 years, p = 0.02). There was no difference in overall complication rate (40.5% vs. 29.6%, p = 0.22) or major complication rate (8.1% vs. 4.8%, p = 0.20) between frail and non-frail patients. Functionally impaired patients (METS < 4) were more likely to develop a major complication (17.9% vs. 3.0%, p < 0.01). Average length of stay was 2.4 days, and frail patients experienced a longer mean hospital stay (2.5 ± 0.2 vs. 2.3 ± 1.8, p = 0.03). Frail patients were more likely to be discharged to a destination other than home. CONCLUSION Increased frailty as assessed by the mFI is correlated with length of stay and discharge destination following laparoscopic repair of giant PEH in patients > 65. Complication rates were comparable for both frail and non-frail cohorts.
Collapse
Affiliation(s)
- Thomas Q Xu
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, HUB 6th Floor, Milwaukee, WI, 5322, USA
| | - Jesse Maguire
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, HUB 6th Floor, Milwaukee, WI, 5322, USA
| | - Jon Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, HUB 6th Floor, Milwaukee, WI, 5322, USA.
| |
Collapse
|
5
|
Bongers BC. Steep ramp test protocol for preoperative risk assessment and short-term high-intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology. J Surg Oncol 2023; 127:891-895. [PMID: 36621860 DOI: 10.1002/jso.27201] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/13/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Affiliation(s)
- 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
| |
Collapse
|
6
|
Pook M, Elhaj H, El Kefraoui C, Balvardi S, Pecorelli N, Lee L, Feldman LS, Fiore JF. Construct validity and responsiveness of the Duke Activity Status Index (DASI) as a measure of recovery after colorectal surgery. Surg Endosc 2022; 36:8490-8497. [PMID: 35212822 DOI: 10.1007/s00464-022-09145-6] [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] [Received: 09/03/2021] [Accepted: 02/15/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Returning to preoperative levels of physical function is highly valued by patients recovering from surgery. The Duke Activity Status Index (DASI, a 12-item questionnaire) may be a simple yet robust tool to assess postoperative recovery of functional capacity. This study assessed construct validity and responsiveness of the DASI as a measure of recovery after colorectal surgery. METHODS Data from a trial on early mobilization after colorectal surgery were analyzed. Patients completed the DASI questionnaire preoperatively and at postoperative weeks (POW) 2 and 4. Construct validity was assessed by testing the primary a priori hypotheses that postoperative DASI scores (1) are higher in patients without vs with postoperative complications and (2) correlate with six-minute walk test distance (6MWD). Exploratory analyses assessed the association between DASI scores and (1) preoperative physical status [higher (ASA ≤ 2) vs lower (ASA > 2)], (2) stoma creation (no stoma vs stoma), (3) age [younger (≤ 75 years) vs older (> 75 years)], (4) time to readiness for discharge [shorter (≤ 4 days) vs longer (> 4 days)], and (5) surgical approach (laparoscopic vs open). Responsiveness was assessed by testing a priori hypotheses that DASI scores are higher (1) preoperatively vs at POW2 and (2) at POW4 vs POW2. Mean differences in DASI scores were obtained using linear regression. The association between DASI and 6MWD was assessed via Pearson correlation. RESULTS We analyzed data from 100 patients undergoing colorectal surgery (mean age 65; 57% male; 81% laparoscopic). Mean DASI scores were 47.9 ± 12.1 preoperatively, 22.4 ± 12.7 at POW2, and 33.2 ± 15.7 at POW4. The data supported our two primary construct validity hypotheses, as well as 3/5 exploratory hypotheses. Both responsiveness hypotheses were supported. CONCLUSIONS Our findings support that the DASI questionnaire can be a useful tool to assess postoperative recovery of functional capacity in research and clinical practice.
Collapse
Affiliation(s)
- Makena Pook
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Hiba Elhaj
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Charbel El Kefraoui
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Saba Balvardi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Nicolo Pecorelli
- Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.
- Department of Surgery, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Montreal General Hospital, 1650 Cedar Ave, R2-104, Montreal, QC, H3G 1A4, Canada.
| |
Collapse
|
7
|
Serra C, Cossiga V, Serenari M, Felicani C, Mazzotta E, Pinato DJ, Cescon M, Ercolani G, Cucchetti A. Safety and efficacy of percutaneous radiofrequency ablation for hepatocellular carcinoma: a textbook outcome analysis. HPB (Oxford) 2022; 24:664-671. [PMID: 34642089 DOI: 10.1016/j.hpb.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/22/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Textbook Outcome (TO) is a quality indicator accounting for both efficacy and safety. Herein, we aimed to assess TO in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (RFA). METHODS All consecutive patients undergoing RFA for HCC between 2014 and 2020, were included. TO was defined as 1) no post-RFA complications or mortality within 30 days after RFA, 2) no prolonged hospital stay 3) no 30-day readmission and 4) the achievement of a complete response (CR) of the target lesion/s at 1-month. RESULTS Overall, 50.3% of 376 patients fulfilled all the quality indicators to achieve TO. Probabilities of TO achievement decreased in presence of moderate comorbidities (odds ratio[OR]:0.43; 95%C.I.:0.22-0.80;p=0.008), a performance status of 1 (OR: 0.58;95%C.I.:0.37-0.89; p=0.013), the treatment of 2 nodules (OR: 0.71; 95%C.I.:0.41-0.98; p=0.048) or ≥3 nodules (OR: 0.41; 95%C.I.: 0.22 - 0.78; p = 0.007); the treatment of 2-3cm nodules (OR:0.49;95%C.I.:0.31-0.79;p=0.003) or >3cm nodules (OR: 0.36;95%C.I.:0.18-0.73;p=0.004). Risk-stratification provided TO achievement ranging between 77.9% and 14.3%. Patients with TO also had improved survival (p = 0.028). CONCLUSION About half of patients get TO from RFA. Stratification by clinical and tumoral characteristic should aid provision of RFA in clinical practice, facilitating patient information and providing reference values for future comparative studies.
Collapse
Affiliation(s)
- Carla Serra
- Department of Organ Insufficiency and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, IRCCS, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Valentina Cossiga
- Department of Organ Insufficiency and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, IRCCS, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Matteo Serenari
- General Surgery and Transplantation Unit, Azienda Ospedaliero-Universitaria di Bologna, IRCCS, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
| | - Cristina Felicani
- Department of Organ Insufficiency and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, IRCCS, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Mazzotta
- Department of Organ Insufficiency and Transplantation, Azienda Ospedaliero-Universitaria di Bologna, IRCCS, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Matteo Cescon
- General Surgery and Transplantation Unit, Azienda Ospedaliero-Universitaria di Bologna, IRCCS, Sant'Orsola-Malpighi Hospital, Bologna, Italy; Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy; Department of Surgery, Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy; Department of Surgery, Morgagni - Pierantoni Hospital, Forlì, Italy
| |
Collapse
|
8
|
Macieira CL, Chiavegato LD, Garcia IFF, Lunardi AC. Perioperative care for major elective surgery: a survey of Brazilian physiotherapists. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Major surgeries are highly complex procedures and have a higher incidence of respiratory morbidity and mortality compared to other types of surgery. Postoperative pulmonary complications (PPC) are common after such surgeries and are associated with increased hospital stay, health care costs and surgical patient mortality. Objective: To investigate the most commonly used physical therapy techniques for the prevention and treatment of PPC among thoracic and abdominal surgery patients in all regions of Brazil. Methods: A total of 489 randomly selected physiotherapists who provided perioperative care for patients undergoing elective abdominal, thoracic or cardiac surgeries participated in this study. A questionnaire with nine questions about routine care and therapeutic choices for the surgical population was developed and assessed by 10 specialists before being administered to the physiotherapists. Results: Among the physiotherapists (63% with at least 5 years of experience with surgical patients), 50.9% considered the patient’s surgical risk in their treatment either always or often. A total of 53.8% patients were treated by the physiotherapist following a physician’s prescription. The most mentioned physical therapy techniques used to prevent PPC were postoperative mobilization/exercises (59.3%), postoperative lung expansion (52.8%), and preoperative advice (50.7%). In addition, 80.6% of the physiotherapists believe that incentive spirometry prevents PPC, while 72.8% expected this effect from positive airway pressure devices. Conclusion: Most physiotherapists in Brazil who work with surgical patients offer preoperative professional advice, use postoperative early mobilization and lung expansion techniques to prevent PPC, and consider the patient's surgical risk during treatment. In addition, some physical therapy sessions are routinely performed preoperatively.
Collapse
|
9
|
Mylius CF, Krijnen WP, Takken T, Lips DJ, Eker H, van der Schans CP, Klaase JM. Objectively measured preoperative physical activity is associated with time to functional recovery after hepato-pancreato-biliary cancer surgery: a pilot study. Perioper Med (Lond) 2021; 10:33. [PMID: 34602089 PMCID: PMC8489102 DOI: 10.1186/s13741-021-00202-7] [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: 10/20/2020] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Surgical resection is currently the cornerstone of hepato-pancreato-biliary (HPB) cancer treatment. A low preoperative aerobic fitness level has been identified as a modifiable risk factor associated with complications after major abdominal surgery. A person's aerobic fitness is influenced by performing moderate to vigorous physical activity (MVPA). This study aims to determine the activity monitor measured levels of MVPA performed among patients on the waiting list for HPB cancer surgery and their association with postoperative outcomes. METHODS A prospective, observational multi-center cohort pilot study was conducted. Patients enlisted for resection surgery on suspicion of HPB (pre)malignancy were enrolled. Performed MVPA was measured by an Actigraph wGT3X-BT. Additionally, aerobic fitness was measured via the Incremental Shuttle Walk Test, and (post)operative variables were collected from the electronic patient files. The association between MVPA and the pre- and postoperative variables was determined by univariate and multivariable (logistic) robust regression. RESULTS A total of 38 participants, median age 66.0 (IQR 58.25-74.75) years, were enrolled. The median daily MVPA was 10.7 (IQR 6.9-18.0) min; only 8 participants met the Dutch MVPA guidelines. Participant's age and aerobic fitness were associated with MVPA by multivariable statistical analysis. Time to functional recovery was 8 (IQR 5-12) days and was associated with MVPA and type of surgery (major/minor) in multivariable analysis. CONCLUSION Seventy-six percent of patients enlisted for resection of HPB (pre)malignancy performed insufficient MVPA. A higher level of MVPA was associated with a shorter time to functional recovery.
Collapse
Affiliation(s)
- Caspar F Mylius
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands.
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands
| | - Tim Takken
- Child Development and Exercise Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan J Lips
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Hasan Eker
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Cees P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Health Psychology Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost M Klaase
- Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Centre Groningen, Groningen, The Netherlands
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Associations between pretreatment physical performance tests and treatment complications in patients with non-small cell lung cancer: A systematic review. Crit Rev Oncol Hematol 2021; 158:103207. [PMID: 33383208 DOI: 10.1016/j.critrevonc.2020.103207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/25/2022] Open
Abstract
This systematic review evaluated which outcome variables and cut-off values of pretreatment exercise tests are associated with treatment complications in patients with stage I-III non-small cell lung cancer (NSCLC). PRISMA and Cochrane guidelines were followed. A total of 38 studies with adult patients undergoing treatment for stage I-III NSCLC who completed pretreatment exercise tests, and of whom treatment-related complications were recorded were included. A lower oxygen uptake at peak exercise amongst several other variables on the cardiopulmonary exercise test and a lower performance on field tests, such as the incremental shuttle walk test, stair-climb test, and 6-minute walk test, were associated with a higher risk for postoperative complications and/or postoperative mortality. Cut-off values were reported in a limited number of studies and were inconsistent. Due to the variety in outcomes, further research is needed to evaluate which outcomes and cut-off values of physical exercise tests are most clinically relevant.
Collapse
|
12
|
Xie W, Levine MA, Aquil S, Pacoli K, Al-Ogaili R, Luke PP, Sener A. Daily use of a muscle pump activator device reduces duration of hospitalization and improves early graft outcomes post-kidney transplantation: A randomized controlled trial. Can Urol Assoc J 2020; 15:26-32. [PMID: 32745003 DOI: 10.5489/cuaj.6487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kidney and simultaneous pancreas-kidney (SPK) transplant recipients can have prolonged postoperative hospitalization due to edema. Thrombo-embolic-deterrent (TED) stockings with intermittent pneumatic compression devices (TED+IPC) have been used to improve venous return during the perioperative period. The objective of this trial was to evaluate the effects of TED+IPC vs. muscle pump activator (MPA) devices on factors that could reduce postoperative complications and duration of hospitalization. METHODS In this single-center, prospective, randomized, controlled trial, 221 kidney and SPK transplant recipients were randomized to either wearing TED+IPC or MPA for six days postoperatively. Groups were compared with respect to postoperative urine output, lower limb edema, weight, days in hospital, mobility, serum creatinine, delayed graft function, need for dialysis, and lower extremity blood flow. RESULTS Patients in the MPA group had significantly higher urine output and less increase in mid-calf leg circumference and weight gain compared to the TED+IPC group (p=0.003, p=0.001, and p=0.003, respectively). The MPA group also experienced shorter hospitalization (p=0.038), higher femoral vein velocity (p=0.001), and took more steps (p=0.009). Incidence of delayed graft function (p=0.72) and number of dialysis runs (p=0.39) was not different between study groups. Subgroup analysis of primary endpoints in donation after cardiac death recipients and SPK recipients did not yield any significance between the study arms. CONCLUSIONS Postoperative use of the MPA device increases urine output, decreases leg edema, minimizes weight gain, and decreases duration of hospitalization after kidney transplantation. A larger and longer-term trial is needed to evaluate the impact on graft function.
Collapse
Affiliation(s)
- Wen Xie
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada
| | - Max A Levine
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada.,Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada
| | - Shahid Aquil
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada
| | - Katharine Pacoli
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Rafid Al-Ogaili
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada
| | - Patrick P Luke
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada.,Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Alp Sener
- Department of Surgery, Schulich School of Medicine & Dentistry, St. Joseph's Hospital, London, ON, Canada.,Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada.,Department of Microbiology & Immunology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
A van Beijsterveld C, Bongers BC, den Dulk M, Dejong CH, van Meeteren NL. Personalized community-based prehabilitation for a high-risk surgical patient opting for pylorus-preserving pancreaticoduodenectomy: a case report. Physiother Theory Pract 2020; 37:1497-1509. [PMID: 32013652 DOI: 10.1080/09593985.2019.1709233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Prehabilitation aims for an optimal physical functioning level before, during, and after hospitalization for major surgery. The purpose of this case report was to illustrate the care pathway of a high-risk patient who opted for pylorus-preserving pancreaticoduodenectomy, including preparation for this procedure by participating in a community-based exercise prehabilitation program. The report describes patient examination, evaluation in decision-making for surgery, the prehabilitation program, and outcomes within the context of the Hypothesis-Oriented Algorithm for Clinicians II.Case Description: The patient was a 75-year-old woman with a history of several comorbidities and a polypoid mass in the descending segment of the duodenum. Based on the preoperative assessment, the level of physical functioning was expected to be insufficient to cope adequately with the stress of hospitalization and surgery.Intervention: A 4-week prehabilitation program, including aerobic, resistance, and functional task training in a community-based physical therapy practice.Outcomes: Prehabilitation had a beneficial impact on improving functional mobility preoperatively (timed up-and-go test score improved from 19.4 to 10.0 s, five times sit-to-stand test score improved from 30.1 to 10.1 s, and two-minute walk test distance improved from 55.0 to 107.0 m). Surgery and postoperative recovery proceeded without complications. She achieved independent physical functioning on postoperative day 6 and was discharged home on postoperative day 12.Conclusion: Preoperative risk-assessment can support clinical decision-making in a high-risk patient opting for major abdominal surgery. Furthermore, a remarkable improvement in physical functioning can be achieved by community-based prehabilitation in a high-risk surgical patient.
Collapse
Affiliation(s)
- Christel A van Beijsterveld
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Physical Therapy, Maastricht University Medical Center, Maastricht, 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.,SOMT University of Physical therapy, Amersfoort, The Netherlands.,Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty, Maastricht University, Maastricht, The Netherlands
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, University Hospital RWTH-Aachen, Aachen, Germany
| | - Cornelis H Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, University Hospital RWTH-Aachen, Aachen, Germany.,Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nico L van Meeteren
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Top Sector Life Sciences and Health (Health∼Holland), The Hague, The Netherlands
| |
Collapse
|