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Asken MJ, Swenson L, Casey T. Mental Health Diagnoses and Surgical Outcomes: Inconsistent Conclusions, But Prehabilitation Holds Promise. J Laparoendosc Adv Surg Tech A 2024; 34:427-429. [PMID: 38324096 DOI: 10.1089/lap.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Affiliation(s)
- Michael J Asken
- Department of Surgery, UPMC Pinnacle Hospitals, Harrisburg, Pennsylvania, USA
| | - Lisa Swenson
- Department of Surgery, UPMC Pinnacle Hospitals, Harrisburg, Pennsylvania, USA
| | - Taylor Casey
- Department of Surgery, General Surgery Residency Program, UPMC Central Pennsylvania Region, Harrisburg, Pennsylvania, USA
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Kovoor JG, Nann SD, Chambers C, Mishra K, Goel S, Thompson I, Koh D, Litwin P, Bacchi S, Harford PJ, Stretton B, Gupta AK. Prehabilitation before general surgery: Worth the effort? J Perioper Pract 2023:17504589231214395. [PMID: 38149496 DOI: 10.1177/17504589231214395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Prehabilitation, or interventions before surgery aimed at improving preoperative health and postoperative outcomes, has various forms. Although it may confer benefit to patients undergoing general surgery, this is not certain. Furthermore, although it may yield a net monetary gain, it is also likely to require substantial monetary and non-monetary investment. The impact of prehabilitation is highly variable and dependent on multiple factors. Physical function and pulmonary outcomes are likely to be improved by most forms of prehabilitation involving physical and multimodal exercise programmes. However, other surgical outcomes have demonstrated mixed results from prehabilitation. Within this issue, the measures used for evaluating baseline patient biopsychosocial health are important, and collecting sufficient data to accurately inform patient-centred prehabilitation programmes is only possible through thorough clinical and laboratory investigation and synthesised metrics such as cardiopulmonary exercise testing. Although a multimodal approach to prehabilitation is the current gold standard, societal factors may affect engagement with programmes that require a significant in-person activity. However, this is weighed against the substantial financial and non-financial investment that accompanies many programmes. The overall effectiveness and optimal mode of intervention across the discipline of general surgery remains unclear, and further research is needed to prove prehabilitation's full worth.
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Affiliation(s)
- Joshua G Kovoor
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Silas D Nann
- Health and Information, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Courtney Chambers
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kritika Mishra
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sahil Goel
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Isabella Thompson
- Gold Coast University Hospital, Gold Coast, QLD, Australia
- Bond University, Gold Coast, QLD, Australia
| | - Dong Koh
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter Litwin
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Stephen Bacchi
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Philip J Harford
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Brandon Stretton
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- The Queen Elizabeth Hospital, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
| | - Aashray K Gupta
- Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia
- Health and Information, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
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Banasiewicz T, Kobiela J, Cwaliński J, Spychalski P, Przybylska P, Kornacka K, Bogdanowska-Charkiewicz D, Leyk-Kolańczak M, Borejsza-Wysocki M, Batycka-Stachnik D, Drwiła R. Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery. POLISH JOURNAL OF SURGERY 2023; 95:62-91. [PMID: 38348849 DOI: 10.5604/01.3001.0053.8854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Jarosław Kobiela
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Spychalski
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Patrycja Przybylska
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Karolina Kornacka
- Oddział Chirurgii Ogólnej, Onkologicznej i Kolorektalnej, Wielospecjalistyczny Szpital Miejski im. J. Strusia, Poznań
| | | | - Magdalena Leyk-Kolańczak
- Zakład Pielęgniarstwa Chirurgicznego, Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Maciej Borejsza-Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Dominika Batycka-Stachnik
- Oddział Kliniczny Chirurgii Serca, Naczyń i Transplantologii, Krakowski Szpital Specjalistyczny im. Św. Jana Pawła II, Kraków
| | - Rafał Drwiła
- Katedra i Zakład Anestezjologii i Intensywnej Terapii, Collegium Medicum Uniwersytet Jagielloński, Kraków
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Pester BD, Wilson JM, Yoon J, Lazaridou A, Schreiber KL, Cornelius M, Campbell CM, Smith MT, Haythornthwaite JA, Edwards RR, Meints SM. Brief Mindfulness-Based Cognitive Behavioral Therapy is Associated with Faster Recovery in Patients Undergoing Total Knee Arthroplasty: A Pilot Clinical Trial. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:576-585. [PMID: 36394250 PMCID: PMC10501468 DOI: 10.1093/pm/pnac183] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/04/2022] [Accepted: 11/10/2022] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To assess whether brief mindfulness-based cognitive behavioral therapy (MBCBT) could enhance the benefits of total knee arthroplasty (TKA) in improving pain and pain-related disability. Specifically, to determine 1) whether patients who received MBCBT differed from matched controls who received treatment-as-usual with regard to postsurgical pain outcomes and 2) whether changes in pain catastrophizing, depression, or anxiety explained the potential effects of MBCBT on pain outcomes. DESIGN Pilot clinical trial. SETTING An academic teaching hospital serving a large urban and suburban catchment area surrounding the Boston, Massachusetts metropolitan region. SUBJECTS Sample of 44 patients undergoing TKA. Patients who completed a brief MBCBT intervention (n = 22) were compared with age-, race-, and sex-matched controls who received treatment-as-usual (n = 22). METHODS The MBCBT intervention included four 60-minute sessions delivered by a pain psychologist in person and via telephone during the perioperative period. Participants were assessed at baseline and at 6 weeks, 3 months, and 6 months after surgery. RESULTS Compared with matched controls, patients who received MBCBT had lower pain severity and pain interference at 6 weeks after surgery. Group differences in outcomes were mediated by changes in pain catastrophizing but not by changes in depression or anxiety. The MBCBT group had similar reductions in pain severity and interference as the control group did at 3 and 6 months after surgery. CONCLUSIONS This work offers evidence for a safe and flexibly delivered nonpharmacological treatment (MBCBT) to promote faster recovery from TKA and identifies change in pain catastrophizing as a mechanism by which this intervention could lead to enhanced pain-related outcomes.
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Affiliation(s)
- Bethany D Pester
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jenna M Wilson
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jihee Yoon
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Asimina Lazaridou
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marise Cornelius
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert R Edwards
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha M Meints
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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