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Wang J, Li S, Hu Y, Ren L, Jiang Y, Yu M, Liu Z, Wu Y, Zhao Y, Zhang J, Li J, Yao Y. The bi-directional relationships between diversified leisure activity participation and cognitive function in older adults in China: separating between-person effects from within-person effects. BMC Geriatr 2024; 24:426. [PMID: 38741042 DOI: 10.1186/s12877-024-04997-0] [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: 02/08/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE To examine the bi-directorial association between diversified leisure activity participation and cognitive function over a 7-year period. METHODS Data analyzed was from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a large-scale longitudinal national study. The baseline survey was conducted in 2011 with follow-up every three years. We traced a total of 2718 participants over a period of 7 years. We used adjusted random intercept cross-lagged panel models (RI-CLPMs) to examine the bi-directorial associations between diversified leisure activity participation and cognitive function. RESULTS We observed bi-directorial associations between diversity of leisure activity and cognitive function across waves at the between-person and within-person levels. The adjusted random intercept cross-lagged panel models fitted the data appropriately, and the 3-year cross-lagged effects of prior diversified leisure activity participation on cognitive function (β = 0.058, p < 0.01) and cognitive function on subsequent diversified leisure activity participation (β = 0.047, p < 0.05) were significant. The results remained after adjusting the model for baseline sex, age, educational level, marital status and current residence, the number of chronic diseases, ADL, depressive symptoms, sleep quality, smoking, and drinking. CONCLUSION This study suggests that a reciprocal causality relationship between diversified leisure activity participation and cognitive function, indicating a "positive circle" that further promotes cognition over time.
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Affiliation(s)
- Jingjing Wang
- School of Public Health, Peking University, Beijing, China
- Center for Health Development Studies, Peking University, Beijing, China
| | - Shaojie Li
- School of Public Health, Peking University, Beijing, China
- Center for Health Development Studies, Peking University, Beijing, China
| | - Yang Hu
- School of Public Health, Peking University, Beijing, China
- Center for Health Development Studies, Peking University, Beijing, China
| | - Longbing Ren
- School of Public Health, Peking University, Beijing, China
- Center for Health Development Studies, Peking University, Beijing, China
| | - Yuling Jiang
- School of Public Health, Peking University, Beijing, China
- Center for Health Development Studies, Peking University, Beijing, China
| | - Mingzhi Yu
- School of Public Health, Peking University, Beijing, China
- Center for Health Development Studies, Peking University, Beijing, China
| | - Zhouwei Liu
- School of Public Health, Peking University, Beijing, China
- Center for Health Development Studies, Peking University, Beijing, China
| | - Yifei Wu
- School of Public Health, Peking University, Beijing, China
- Center for Health Development Studies, Peking University, Beijing, China
| | - Yejin Zhao
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Zhang
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Li
- Department of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
| | - Yao Yao
- Center for Health Development Studies, Peking University, Beijing, China.
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Sibley D, Chen M, West MA, Matthew AG, Santa Mina D, Randall I. Potential mechanisms of multimodal prehabilitation effects on surgical complications: a narrative review. Appl Physiol Nutr Metab 2023; 48:639-656. [PMID: 37224570 DOI: 10.1139/apnm-2022-0272] [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: 05/26/2023]
Abstract
Continuous advances in prehabilitation research over the past several decades have clarified its role in improving preoperative risk factors, yet the evidence demonstrating reduced surgical complications remains uncertain. Describing the potential mechanisms underlying prehabilitation and surgical complications represents an important opportunity to establish biological plausibility, develop targeted therapies, generate hypotheses for future research, and contribute to the rationale for implementation into the standard of care. In this narrative review, we discuss and synthesize the current evidence base for the biological plausibility of multimodal prehabilitation to reduce surgical complications. The goal of this review is to improve prehabilitation interventions and measurement by outlining biologically plausible mechanisms of benefit and generating hypotheses for future research. This is accomplished by synthesizing the available evidence for the mechanistic benefit of exercise, nutrition, and psychological interventions for reducing the incidence and severity of surgical complications reported by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). This review was conducted and reported in accordance with a quality assessment scale for narrative reviews. Findings indicate that prehabilitation has biological plausibility to reduce all complications outlined by NSQIP. Mechanisms for prehabilitation to reduce surgical complications include anti-inflammation, enhanced innate immunity, and attenuation of sympathovagal imbalance. Mechanisms vary depending on the intervention protocol and baseline characteristics of the sample. This review highlights the need for more research in this space while proposing potential mechanisms to be included in future investigations.
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Affiliation(s)
- Daniel Sibley
- Faculty of Kinesiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Maggie Chen
- Faculty of Kinesiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Malcolm A West
- Faculty of Medicine, Cancer Sciences, University of Southampton, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew G Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Ian Randall
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Engel D, Testa GD, McIsaac DI, Carli F, Santa Mina D, Baldini G, Scheede-Bergdahl C, Chevalier S, Edgar L, Beilstein CM, Huber M, Fiore JF, Gillis C. Reporting quality of randomized controlled trials in prehabilitation: a scoping review. Perioper Med (Lond) 2023; 12:48. [PMID: 37653530 PMCID: PMC10472732 DOI: 10.1186/s13741-023-00338-8] [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: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Inadequate study reporting precludes interpretation of findings, pooling of results in meta-analyses, and delays knowledge translation. While prehabilitation interventions aim to enhance candidacy for surgery, to our knowledge, a review of the quality of reporting in prehabilitation has yet to be conducted. Our objective was to determine the extent to which randomized controlled trials (RCTs) of prehabilitation are reported according to methodological and intervention reporting checklists. METHODS Eligibility criteria: RCTs of unimodal or multimodal prehabilitation interventions. SOURCES OF EVIDENCE search was conducted in March 2022 using MEDLINE, Embase, PsychINFO, Web of Science, CINAHL, and Cochrane. CHARTING METHODS identified studies were compared to CONSORT, CERT & Modified CERT, TIDieR, PRESENT, and CONSORT-SPI. An agreement ratio (AR) was defined to evaluate if applicable guideline items were correctly reported. Data were analyzed as frequency (n, %) and mean with standard deviation (SD). RESULTS We identified 935 unique articles and included 70 trials published from 1994 to 2022. Most prehabilitation programs comprised exercise-only interventions (n = 40, 57%) and were applied before oncologic surgery (n = 32, 46%). The overall mean AR was 57% (SD: 20.9%). The specific mean ARs were as follows: CONSORT: 71% (SD: 16.3%); TIDieR: 62% (SD:17.7%); CERT: 54% (SD: 16.6%); Modified-CERT: 40% (SD:17.8%); PRESENT: 78% (SD: 8.9); and CONSORT-SPI: 47% (SD: 22.1). CONCLUSION Altogether, existing prehabilitation trials report approximately half of the checklist items recommended by methodological and intervention reporting guidelines. Reporting practices may improve with the development of a reporting checklist specific to prehabilitation interventions.
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Affiliation(s)
- Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Giuseppe Dario Testa
- Department of Anesthesia, McGill University, Montréal, QC, Canada
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Department of Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Daniel Santa Mina
- Department of Anesthesia and Pain Management, Faculty of Medicine, Faculty of Kinesiology and Physical Education, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gabriele Baldini
- Section of Anesthesiology, Intensive Care and Pain Medicine, Anesthesiology and Intensive Care Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
- Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Linda Edgar
- Prehabilitation Clinic, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada
| | - Chelsia Gillis
- Department of Anesthesia, McGill University, Montréal, QC, Canada.
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada.
- Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada.
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Rabey M, Kendell M, Shea YL, Mattinson D, Koh YFN, Seow KC, Beales D. Interaction analyses: Enhancing understanding of chronic low back pain. Musculoskelet Sci Pract 2023; 64:102728. [PMID: 36804720 DOI: 10.1016/j.msksp.2023.102728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Chronic low back pain (CLBP) is complex. Statistical examination of influences of exposures (e.g. characteristics) upon outcomes (e.g. pain) facilitates understanding of complexity and personalized care. Psychological factors may be associated with higher disability following exercise in CLBP. Examining interactions of psychological variables with exercise on disability might further understanding of CLBP. OBJECTIVES Secondary analysis of data from a CLBP cohort evaluating interactions between psychological variables and exercise on disability. DESIGN Longitudinal cohort study. METHOD Variables from a published prognostic model for disability: disability (baseline/one-year follow-up), psychological principal component scores (principal component score two (PC2) - Fear-avoidance beliefs, pain catastrophizing, pain self-efficacy; principal component score three (PC3) - thought suppression, behavioral endurance), exercise (during follow-up), forward-bending time, punishing significant other responses. Differences between exercisers and non-exercisers were assessed using Chi-Squared/Mann-Whitney tests. Multivariable linear regression models for follow-up disability included a term examining interaction between principal component scores and exercise. RESULTS Exercisers had significantly different scores for PC2 (p = .02) and PC3 (p = .03), lower baseline (p = .005) and follow-up pain intensity (p < .001), follow-up disability (p < .001) and faster forward-bend times (p = .014). There was no significant interaction between exercise and PC2 (p = .92) or PC3 (p = .75). CONCLUSIONS This study showed no interaction between psychological factors and exercise on disability at follow-up. These findings suggest that the disability outcome of people with CLBP who undertake exercise as an intervention does not differ from those who do not undertake exercise, irrespective of their baseline psychological status.
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Affiliation(s)
- Martin Rabey
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia.
| | - Michelle Kendell
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Yik Lui Shea
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Deb Mattinson
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Yi Fan Nathan Koh
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Kuang Cheng Seow
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
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He Y, Zou W, Han X, Chen C, Zhang A, Sun N. Cognitive prehabilitation for geriatric patients undergoing elective surgery: a PRISMA-P-compliant protocol for a systematic review. BMJ Open 2022; 12:e060369. [PMID: 35798527 PMCID: PMC9263908 DOI: 10.1136/bmjopen-2021-060369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The ageing of the population, as well as advances and improvements in surgery, and anaesthesia have greatly increased the demand for surgical services in geriatric patients. Neurocognitive disorders are the most common complications experienced in the postoperative period by older individuals. Improving perioperative brain health in older adults has become key actions for the multidisciplinary perioperative care teams. This comprehensive systematic review will assess the effectiveness and safety of cognitive prehabilitation programmes prior to surgery on cognitive functional capacity and postoperative cognitive outcomes in geriatric patients undergoing elective surgery. METHODS AND ANALYSIS This protocol was prepared using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The following key electronic bibliographic databases will be searched from inception to July 2022: MEDLINE, EMBASE, CINAHL, CENTRAL, PEDro, PsycINFO, CBM, CNKI, WANFANG database and VIP. We will include randomised controlled trials published in English or Chinese that examine the effects of cognitive prehabilitation programmes on geriatric patients undergoing elective surgery. To construct the search strategy, the Patient, Intervention, Comparison, Outcome, Study scheme will be used. Two reviewers will independently complete the study screening, selection, data extraction and quality rating. The Physiotherapy Evidence Database scale will be used to assess the methodological quality of the included studies. A narrative or quantitative synthesis will be conducted based on the final data. The planned start and end dates for the study were 1 September 2021 and 1 August 2023. ETHICS AND DISSEMINATION Ethical approval will not be required for this protocol. The results of the final review will be disseminated via peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021277191.
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Affiliation(s)
- Yu He
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenchen Zou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaochai Han
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Caitao Chen
- Department of Rehabilitation, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Anren Zhang
- Department of Rehabilitation, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Nianyi Sun
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Rehabilitation, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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McGinigle KL, Spangler EL, Pichel AC, Ayyash K, Arya S, Settembrini AM, Garg J, Thomas MM, Dell KE, Swiderski IJ, Lindo F, Davies MG, Setacci C, Urman RD, Howell SJ, Ljungqvist O, de Boer HD. Perioperative care in open aortic vascular surgery: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery. J Vasc Surg 2022; 75:1796-1820. [PMID: 35181517 DOI: 10.1016/j.jvs.2022.01.131] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022]
Abstract
The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS®) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based recommendations related to all of the health care received in the perioperative period for patients undergoing open abdominal aortic operations (both transabdominal and retroperitoneal approaches, including supraceliac, suprarenal, and infrarenal clamp sites, for aortic aneurysm and aortoiliac occlusive disease). Structured around the ERAS® core elements, 36 recommendations were made and organized into preadmission, preoperative, intraoperative, and postoperative recommendations.
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Affiliation(s)
- Katharine L McGinigle
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Emily L Spangler
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Adam C Pichel
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Katie Ayyash
- Department of Perioperative Medicine (Merit), York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Shipra Arya
- Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | | | - Joy Garg
- Department of Vascular Surgery, Kaiser Permanente San Leandro, San Leandro, CA
| | - Merin M Thomas
- Lenox Hill Hospital, Northwell Health, New Hyde Park, NY
| | | | | | - Fae Lindo
- Stanford University Hospital, Palo Alto, CA
| | - Mark G Davies
- Department of Surgery, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Sciences Center, San Antonio, TX
| | - Carlo Setacci
- Department of Surgery, University of Siena, Siena, Italy
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Simon J Howell
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Olle Ljungqvist
- Department of Surgery, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedure Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands
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Gillis C, Ljungqvist O, Carli F. Prehabilitation, enhanced recovery after surgery, or both? A narrative review. Br J Anaesth 2022; 128:434-448. [PMID: 35012741 DOI: 10.1016/j.bja.2021.12.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/03/2021] [Accepted: 12/05/2021] [Indexed: 12/12/2022] Open
Abstract
This narrative review presents a biological rationale and evidence to describe how the preoperative condition of the patient contributes to postoperative morbidity. Any preoperative condition that prevents a patient from tolerating the physiological stress of surgery (e.g. poor cardiopulmonary reserve, sarcopaenia), impairs the stress response (e.g. malnutrition, frailty), and/or augments the catabolic response to stress (e.g. insulin resistance) is a risk factor for poor surgical outcomes. Prehabilitation interventions that include exercise, nutrition, and psychosocial components can be applied before surgery to strengthen physiological reserve and enhance functional capacity, which, in turn, supports recovery through attaining surgical resilience. Prehabilitation complements Enhanced Recovery After Surgery (ERAS) care to achieve optimal patient outcomes because recovery is not a passive process and it begins preoperatively.
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Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada.
| | - Olle Ljungqvist
- Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada
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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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Gillis C, Phillips SM. Protein for the Pre-Surgical Cancer Patient: a Narrative Review. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00494-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gillis C, Fenton TR, Gramlich L, Keller HH, Sajobi TT, Culos-Reed N, Richer L, Awasthi R, Carli F. Malnutrition modifies the response to multimodal prehabilitation: A pooled analysis of prehabilitation trials. Appl Physiol Nutr Metab 2021; 47:141-150. [PMID: 34587460 DOI: 10.1139/apnm-2021-0299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Patients with colorectal cancer are at risk of malnutrition before surgery. Multimodal prehabilitation (nutrition, exercise, stress reduction) readies patients physically and mentally for their operation. However, it is unclear whether extent of malnutrition influences prehabilitation outcomes. METHODS We conducted a pooled analysis from five 4-week multimodal prehabilitation trials in colorectal cancer surgery (prehabilitation: n=195; control: n=71). Each patient's nutritional status was evaluated at baseline using the Patient-Generated Subjective Global Assessment (PG-SGA; higher score, greater need for treatment of malnutrition). Functional walking capacity was measured with the six-minute walk test (6MWD) at baseline and before surgery. A multivariable mixed effects logistic regression model evaluated the potential modifying effect of PG-SGA on a clinically meaningful change of >=19m in 6MWD before surgery. RESULTS Multimodal prehabilitation increased the odds by 3.4 times that colorectal cancer patients improved their 6MWD before surgery as compared to control (95%CI:1.6 to 7.3; P=0.001, n=220). Nutritional status significantly modified this outcome (P=0.007): Neither those patients with PG-SGA>=9 (adjusted odds ratio:1.3; 95% CI: 0.23 to 7.2, P=0.771, n=39) nor PG-SGA <4 (adjusted odds ratio:1.3; 95% CI: 0.5 to 3.8, P=0.574, n=87) improved in 6MWD with prehabilitation. CONCLUSION Baseline nutritional status modifies prehabilitation effectiveness before colorectal cancer surgery. Patients with a PG-SGA score 4-8 appear to benefit most (physically) from 4 weeks of multimodal prehabilitation. Novelty bullets: 1) Nutritional status is an effect modifier of prehabilitation physical function outcomes; 2) Patients with a PG-SGA score 4-8 benefited physically from 4 weeks of multimodal prehabilitation.
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Affiliation(s)
| | - Tanis R Fenton
- University of Calgary, 2129, Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, 1403 29th Street NW, Calgary, Alberta, Canada, T2N 2T9.,Alberta Health Services, Nutrition Services, Calgary, Alberta, Canada;
| | - Leah Gramlich
- University of Alberta, Gastroenterology, 214 csc RAH, Edmonton, Alberta, Canada, T5H 3V9.,ualberta, medicine;
| | | | | | - Nicole Culos-Reed
- University of Calgary, Department of Kinesiology, Calgary, Alberta, Canada;
| | | | - Rashami Awasthi
- McGill University, Department of Anesthesia, Montreal General Hospital, Montreal, Quebec, Canada;
| | - Francesco Carli
- McGill University, Department of Anesthesia, Montreal General Hospital, Montreal, Quebec, Canada, H4B1R6;
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Martin L, Gillis C, Ljungqvist O. Preoperative nutrition care in Enhanced Recovery After Surgery programs: are we missing an opportunity? Curr Opin Clin Nutr Metab Care 2021; 24:453-463. [PMID: 34155154 DOI: 10.1097/mco.0000000000000779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW A key component of Enhanced Recovery After Surgery (ERAS) is the integration of nutrition care elements into the surgical pathway, recognizing that preoperative nutrition status affects outcomes of surgery and must be optimized for recovery. We reviewed the preoperative nutrition care recommendations included in ERAS Society guidelines for adults undergoing major surgery and their implementation. RECENT FINDINGS All ERAS Society guidelines reviewed recommend preoperative patient education to describe the procedures and expectations of surgery; however, only one guideline specifies inclusion of routine nutrition education before surgery. All guidelines included a recommendation for at least one of the following nutrition care elements: nutrition risk screening, nutrition assessment, and nutrition intervention. However, the impact of preoperative nutrition care could not be evaluated because it was rarely reported in recent literature for most surgical disciplines. A small number of studies reported on the preoperative nutrition care elements within their ERAS programs and found a positive impact of ERAS implementation on nutrition care practices, including increased rates of nutrition risk screening. SUMMARY There is an opportunity to improve the reporting of preoperative nutrition care elements within ERAS programs, which will enhance our understanding of how nutrition care elements influence patient outcomes and experiences.
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Affiliation(s)
- Lisa Martin
- Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Chelsia Gillis
- Department of Anesthesia, McGill University Health Center, Québec, Canada
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
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Montroni I, Saur NM, Shahrokni A, Suwanabol PA, Chesney TR. Surgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve Care. J Clin Oncol 2021; 39:2090-2101. [PMID: 34043436 PMCID: PMC10476754 DOI: 10.1200/jco.21.00143] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/20/2021] [Accepted: 04/07/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- Isacco Montroni
- Colon and Rectal Surgery, Ospedale “per gli Infermi”, AUSL Romagna, Faenza, Italy
| | - Nicole M. Saur
- Division of Colon and Rectal Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Armin Shahrokni
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pasithorn A. Suwanabol
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Tyler R. Chesney
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Gillis C, Davies SJ, Carli F, Wischmeyer PE, Wootton SA, Jackson AA, Riedel B, Marino LV, Levett DZH, West MA. Current Landscape of Nutrition Within Prehabilitation Oncology Research: A Scoping Review. Front Nutr 2021; 8:644723. [PMID: 33898499 PMCID: PMC8062858 DOI: 10.3389/fnut.2021.644723] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Prehabilitation aims to improve functional capacity prior to cancer treatment to achieve better psychosocial and clinical outcomes. Prehabilitation interventions vary considerably in design and delivery. In order to identify gaps in knowledge and facilitate the design of future studies, we undertook a scoping review of prehabilitation studies to map the range of work on prehabilitation being carried out in any cancer type and with a particular focus on diet or nutrition interventions. Objectives: Firstly, to describe the type of prehabilitation programs currently being conducted. Secondly, to describe the extent to which prehabilitation studies involved aspects of nutrition, including assessment, interventions, implementation, and outcomes. Eligibility Criteria: Any study of quantitative or qualitative design that employed a formal prehabilitation program before cancer treatment ("prehabilitation" listed in keywords, title, or abstract). Sources of Evidence: Search was conducted in July 2020 using MEDLINE, PubMed, EMBASE, EMCARE, CINAHL, and AMED. Charting Methods: Quantitative data were reported as frequencies. Qualitative nutrition data were charted using a framework analysis that reflects the Nutrition Care Process Model: assessment, intervention, and monitoring/evaluation of the nutrition intervention. Results: Five hundred fifty unique articles were identified: 110 studies met inclusion criteria of a formal prehabilitation study in oncology. prehabilitation studies were mostly cohort studies (41%) or randomized-controlled trials (38%) of multimodal (49%), or exercise-only (44%) interventions that were applied before surgery (94%). Nutrition assessment was inconsistently applied across these studies, and often conducted without validated tools (46%). Of the 110 studies, 37 (34%) included a nutrition treatment component. Half of these studies provided the goal for the nutrition component of their prehabilitation program; of these goals, less than half referenced accepted nutrition guidelines in surgery or oncology. Nutrition interventions largely consisted of counseling with dietary supplementation. The nutrition intervention was indiscernible in 24% of studies. Two-thirds of studies did not monitor the nutrition intervention nor evaluate nutrition outcomes. Conclusion: Prehabilitation literature lacks standardized and validated nutritional assessment, is frequently conducted without evidence-based nutrition interventions, and is typically implemented without monitoring the nutrition intervention or evaluating the intervention's contribution to outcomes. We suggest that the development of a core outcome set could improve the quality of the studies, enable pooling of evidence, and address some of the research gaps identified.
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Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Sarah J. Davies
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Paul E. Wischmeyer
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Stephen A. Wootton
- Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
- National Institute of Health Research Cancer and Nutrition Collaboration, Southampton, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
- National Institute of Health Research Cancer and Nutrition Collaboration, Southampton, United Kingdom
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Anaethesia, Pain and Perioperative Medicine Unit, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Integrated Critical Care Medicine and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Luise V. Marino
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- National Institute of Health Research Cancer and Nutrition Collaboration, Southampton, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
- Nutrition and Dietetics, Faculty of Health and Well Being, University of Winchester, Winchester, United Kingdom
| | - Denny Z. H. Levett
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
- Anaesthesia, Perioperative and Critical Care Research Group, National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Malcolm A. West
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
- Anaesthesia, Perioperative and Critical Care Research Group, National Institute for Health Research Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust, University of Southampton, Southampton, United Kingdom
- Faculty of Medicine, School of Cancer Sciences, University of Southampton, Southampton, United Kingdom
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Gillis C, Carli F. Patients with poor functional walking capacity experience significantly more medical complications post-colorectal surgery than those with higher functional walking capacity. Eur J Surg Oncol 2021; 47:1230-1231. [PMID: 33685726 DOI: 10.1016/j.ejso.2021.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada.
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