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van Rooijen S, Carli F, Dalton S, Thomas G, Bojesen R, Le Guen M, Barizien N, Awasthi R, Minnella E, Beijer S, Martínez-Palli G, van Lieshout R, Gögenur I, Feo C, Johansen C, Scheede-Bergdahl C, Roumen R, Schep G, Slooter G. Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation. BMC Cancer 2019; 19:98. [PMID: 30670009 PMCID: PMC6341758 DOI: 10.1186/s12885-018-5232-6] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 12/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most prevalent type of cancer in the world. Surgery is the only curative option. However, postoperative complications occur in up to 50% of patients and are associated with higher morbidity and mortality rates, lower health related quality of life (HRQoL) and increased expenditure in health care. The number and severity of complications are closely related to preoperative functional capacity, nutritional state, psychological state, and smoking behavior. Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes. However, recent evidence shows that the preoperative period might be the optimal moment for intervention. This study will determine the impact of multimodal prehabilitation on patients' functional capacity and postoperative complications. METHODS/DESIGN This international multicenter, prospective, randomized controlled trial will include 714 patients undergoing colorectal surgery for cancer. Patients will be allocated to the intervention group, which will receive 4 weeks of prehabilitation (group 1, prehab), or the control group, which will receive no prehabilitation (group 2, no prehab). Both groups will receive perioperative care in accordance with the enhanced recovery after surgery (ERAS) guidelines. The primary outcomes for measurement will be functional capacity (as assessed using the six-minute walk test (6MWT)) and postoperative status determined with the Comprehensive Complication Index (CCI). Secondary outcomes will include HRQoL, length of hospital stay (LOS) and a cost-effectiveness analysis. DISCUSSION Multimodal prehabilitation is expected to enhance patients' functional capacity and to reduce postoperative complications. It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer. TRIAL REGISTRATION Trial Registry: NTR5947 - date of registration: 1 August 2016.
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Affiliation(s)
- Stefanus van Rooijen
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Francesco Carli
- Department of Anesthesiology, the Montréal General Hospital, McGill University, Montréal, Canada
| | - Susanne Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gwendolyn Thomas
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Rasmus Bojesen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Morgan Le Guen
- Department of Anesthesiology, Foch Hôpital, Paris, France
| | | | - Rashami Awasthi
- Department of Anesthesiology, the Montréal General Hospital, McGill University, Montréal, Canada
| | - Enrico Minnella
- Department of Anesthesiology, the Montréal General Hospital, McGill University, Montréal, Canada
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Graciela Martínez-Palli
- Department of Anesthesiology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Ismayil Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Carlo Feo
- Department of Surgery, S. Anna University Hospital, Ferrara, Italy
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Celena Scheede-Bergdahl
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Department of Kinesiology and Physical Education, McGill University, Montréal, Canada
| | - Rudi Roumen
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Goof Schep
- Department of Sports Medicine, Máxima Medical Center, Veldhoven, the Netherlands
| | - Gerrit Slooter
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Surgery, Máxima Medical Center, P.O. Box 7777, Veldhoven, the Netherlands
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Althaus A, Hinrichs-Rocker A, Chapman R, Becker OA, Lefering R, Simanski C, Weber F, Moser KH, Joppich R, Trojan S, Gutzeit N, Neugebauer E. Development of a risk index for the prediction of chronic post-surgical pain. Eur J Pain 2011; 16:901-10. [DOI: 10.1002/j.1532-2149.2011.00090.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2011] [Indexed: 11/12/2022]
Affiliation(s)
- A. Althaus
- Institute for Research in Operative Medicine (IFOM), Faculty of Medicine; University of Witten/Herdecke; Cologne; Germany
| | - A. Hinrichs-Rocker
- Institute for Research in Operative Medicine (IFOM), Faculty of Medicine; University of Witten/Herdecke; Cologne; Germany
| | - R. Chapman
- Pain Research Center, Department of Anesthesiology; University of Utah; Salt Lake City; UT; USA
| | - O. Arránz Becker
- Department of Sociology; Chemnitz University of Technology; Chemnitz; Germany
| | - R. Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Medicine; University of Witten/Herdecke; Cologne; Germany
| | - C. Simanski
- Department of Trauma and Orthopedic Surgery; University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC); Cologne; Germany
| | - F. Weber
- Department of Neurosurgery; University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC); Cologne; Germany
| | - K.-H. Moser
- Centre for Ambulant Surgery; Cologne; Germany
| | - R. Joppich
- Department of Anesthesiology and Intensive Care Medicine; University Hospital Witten/Herdecke; Cologne; Germany
| | - S. Trojan
- Department of Anesthesiology and Intensive Care Medicine; University Hospital Witten/Herdecke; Cologne; Germany
| | - N. Gutzeit
- Institute for Research in Operative Medicine (IFOM), Faculty of Medicine; University of Witten/Herdecke; Cologne; Germany
| | - E. Neugebauer
- Institute for Research in Operative Medicine (IFOM), Faculty of Medicine; University of Witten/Herdecke; Cologne; Germany
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Kalkman JC, Visser K, Moen J, Bonsel JG, Grobbee ED, Moons MKG. Preoperative prediction of severe postoperative pain. Pain 2003; 105:415-423. [PMID: 14527702 DOI: 10.1016/s0304-3959(03)00252-5] [Citation(s) in RCA: 392] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We developed and validated a prediction rule for the occurrence of early postoperative severe pain in surgical inpatients, using predictors that can be easily documented in a preoperative setting. A cohort of surgical inpatients (n=1416) undergoing various procedures except cardiac surgery and intracranial neurosurgery in a University Hospital were studied. Preoperatively the following predictors were collected: age, gender, type of scheduled surgery, expected incision size, blood pressure, heart rate, Quetelet index, the presence and severity of preoperative pain, health-related quality of life the (SF-36), Spielberger's State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The outcome was the presence of severe postoperative pain (defined as Numeric Rating Scale > or =8) within the first hour postoperatively. Multivariate logistic regression in combination with bootstrapping techniques (as a method for internal validation) was used to derive a stable prediction model. Independent predictors of severe postoperative pain were younger age, female gender, level of preoperative pain, incision size and type of surgery. The area under the receiver operator characteristic (ROC) curve was 0.71 (95% CI: 0.68-0.74). Adding APAIS scores (measures of preoperative anxiety and need for information), but not STAI, provided a slightly better model (ROC area 0.73). The reliability of this extended model was good (Hosmer and Lemeshow test p-value 0.78). We have demonstrated that severe postoperative pain early after awakening from general anesthesia can be predicted with a scoring rule, using a small set of variables that can be easily obtained from all patients at the preoperative visit. Before this internally validated preoperative prediction rule can be applied in clinical practice to support anticipatory pain management, external validation in other clinical settings is necessary.
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Affiliation(s)
- J C Kalkman
- Department of Anesthesiology, Division of Perioperative Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Abstract
OBJECTIVE To critically evaluate the interpretation of the findings reported in the peer-reviewed literature concerning the association of state and trait anxiety with surgical recovery and response to surgery. METHODS The Social Science Citation Index (SSCI), Science Citation Index (SCI), Medline and Psychological Abstracts (PsycInfo) databases were searched for studies published since 1981. Reference lists from previous reviews were also searched for additional references. Studies that were not in the public domain were not searched for. RESULTS Twenty-seven studies were identified by the search strategy, met the inclusion criteria and contributed to the review. CONCLUSIONS Associations between preoperative measures of anxiety and postoperative mood and pain have been consistently reported. Associations with regard to other recovery variables are less consistent. The existing evidence does not rule out an interpretation of the results as reflecting consistent self-reporting bias rather than causal association.
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Affiliation(s)
- M R Munafò
- University of Southampton, Southampton, UK.
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