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Detemble C, Heil J, Malkomes P, Faqar Uz Zaman F, Sliwinski S, Stickl F, Werneburg E, Faqar Uz Zaman F, Bechstein WO, Schnitzbauer AA. [Digital applications in prehabilitation before major visceral surgery procedures]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:436-442. [PMID: 38649473 DOI: 10.1007/s00104-024-02078-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Prehabilitation is of becoming of growing interest in the medical specialist societies, especially before major surgical procedures in older and frail patients. The body of evidence in steadily growing. OBJECTIVES Are there good digital solutions for a remote prehabilitation program at home? METHODS Narrative review of the evidence and current study activities in analogous and digital prehabilitation. RESULTS Prehabilitation is becoming increasingly more important in the optimal preparation of patients before major surgical procedures. With the help of tailored programs patients can be improved and the risk of complications can be significantly lowered. With an optimal selection, this is not associated with a deterioration of the prognosis for patients with cancer during the intervention lasting for 3-6 weeks. There is still a lack of results and good evidence from well-designed trials for digital solutions. CONCLUSION Prehabilitation can be safely implemented in the preparation of patients before major surgical procedures. Digital solutions are currently being developed and tested and could possibly increase the acceptance in the currently intensifying resource shortages.
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Affiliation(s)
- Charlotte Detemble
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Jan Heil
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Patrizia Malkomes
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Fatima Faqar Uz Zaman
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Svenja Sliwinski
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Franziska Stickl
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Elisabeth Werneburg
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Fatima Faqar Uz Zaman
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Wolf O Bechstein
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Andreas A Schnitzbauer
- Klinik für Allgemein‑, Viszeral‑, Transplantations- und Thoraxchirurgie, Universitätsklinikum Frankfurt am Main, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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Dal Bello S, Mancin S, Morales Palomares S, Lopane D, Di Gianfrancesco L, Soligo C, Tarantino T, Perdonò P, Hurle R, Bernardini B, Piccioni F, Pastore M, Pellegrinelli A, Porreca A, Mazzoleni B. Nutritional Prehabilitation in Patients Undergoing Cystectomy: A Systematic Review. Nutrients 2024; 16:1682. [PMID: 38892615 PMCID: PMC11174884 DOI: 10.3390/nu16111682] [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: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND/AIM Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation before cystectomy. METHODS A systematic literature review was conducted in PubMed, the Cochrane Library, CINAHL, Scopus and the Web of Science databases. Quality and risk of bias assessment was conducted adhering to the JBI framework and evidence was evaluated according to the Oxford Centre for Evidence Based Medicine levels of evidence. RESULTS Out of 586 records identified, six studies were included. Among them, only two were randomized controlled trials. Immunonutrition has been shown to improve postoperative bowel function (3.12 vs. 3.74 days; RR 0.82; CI, 0.73-0.93; p = 0.0029) and decrease postoperative complications (-36.7%; p = 0.008) and readmission rates (-15.38%; p = 0.03). Furthermore, oral nutritional supplements combined with nutritional counseling demonstrated an accelerated recovery of bowel function (-1 day; p < 0.01), a reduction in the length of hospital stay (-1.75 days; p = 0.01), an improvement in handgrip strength (+6.8%, p < 0.001), an increase in bone mass (+0.3 kg, p = 0.04), and a better BMI value (+2.3%, p = 0.001). CONCLUSIONS Nutritional prehabilitation demonstrates potential in enhancing postoperative outcomes following radical cystectomy. Oral supplements, immunonutrition, and counseling exhibit efficacy in improving postoperative results.
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Affiliation(s)
- Susy Dal Bello
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | | | - Sara Morales Palomares
- Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, 87036 Rende, Italy
| | - Diego Lopane
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Luca Di Gianfrancesco
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Chiara Soligo
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Tommaso Tarantino
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Paolo Perdonò
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Rodolfo Hurle
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | | | | | | | | | - Angelo Porreca
- Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (S.D.B.); (C.S.); (T.T.); (P.P.)
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
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Sliwinski S, Faqar-Uz-Zaman SF, Heil J, Mohr L, Detemble C, Dreilich J, Zmuc D, Bechstein WO, Becker S, Chun F, Derwich W, Schreiner W, Solbach C, Fleckenstein J, Filmann N, Schnitzbauer AA. Predictive value of a novel digital risk calculator to determine early patient outcomes after major surgery: a proof-of-concept pilot study. Patient Saf Surg 2024; 18:13. [PMID: 38610002 PMCID: PMC11010393 DOI: 10.1186/s13037-024-00395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND A structured risk assessment of patients with validated and evidence-based tools can help to identify modifiable factors before major surgeries. The Protego Maxima trial investigated the value of a new digitized risk assessment tool that combines tools which can be easily used and implemented in the clinical workflow by doctors and qualified medical staff. The hypothesis was that the structured assessment and risk-grouping is predictive of short-term surgical quality reflected by complications and overall survival. METHODS The Protego Maxima Trial was a prospective cohort analysis of patients undergoing major surgery (visceral, thoracic, urology, vascular and gynecologic surgeries) as key inclusion criterion and the absence of an acute or acute on chronically decompensated pulmo-cardiovascular decompensation. Patients were risk-scored with the software (The Prehab App) that includes a battery of evidence-based risk assessment tools that allow a structured risk assessment. The data were grouped to predefined high and low risk groups and aggregate and individual scores. The primary outcome was to validate the predictive value of the RAI score and the TUG for overall survival in the high and low risk groups. Secondary outcomes were surgical outcomes at 90-days after surgery (overall survival, Clavien-Dindo (CD) 1-5 (all complications), and CD 3-5 (major complications)). The study was carried out in accordance with the DIN ISO 14,155, and the medical device regulation (MDR) at Frankfurt University Hospital between March 2022 and January 2023. RESULTS In total 267 patients were included in the intention to treat analysis. The mean age was 62.1 ± 12.4 years. Patients with a RAI score > 25 and/or a timed up and go (TUG) > 8 s had a higher risk for mortality at 90 days after surgery. The low-risk group predicted beneficial outcome and the high-risk group predicted adverse outcome in the ROC analysis (Area Under the Curve Receiver Operator Characteristics: AUROC > 0.800; p = 0.01). Risk groups (high vs. low) showed significant differences for 90-day survival (99.4% vs. 95.5%; p = 0.04) and major complications (16.4% vs. 32.4%; p < 0.001). CONCLUSION The proof-of-concept trial showed that a risk assessment with 'The Prehab App' may be viable to estimate the preoperative risk for mortality and major complications before major surgeries. The overall performance in this initial set of data indicated a certain reliability of the scoring and risk grouping, especially of the RAI score and the TUG. A larger data set will be required to proof the generalizability of the risk scoring to every subgroup and may be fostered by artificial intelligence approaches. TRIAL REGISTRATION Ethics number: 2021-483-MDR/MPDG-zuständig monocentric; The Federal Institute for Pharmaceuticals and Medical Devices/BfArM, reference number: 94.1.04-5660-13655; Eudamed: CIV-21-07-0307311; German Clinical Trial Registry: DRKS 00026985.
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Affiliation(s)
- Svenja Sliwinski
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Sara Fatima Faqar-Uz-Zaman
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Jan Heil
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Lisa Mohr
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Charlotte Detemble
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Julia Dreilich
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Dora Zmuc
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Wolf O Bechstein
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Sven Becker
- Department for Gynecology, Frankfurt University Hospital, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Felix Chun
- Department for Urology, Frankfurt University Hospital, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Wojciech Derwich
- Department for Vascular Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Waldemar Schreiner
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Christine Solbach
- Department for Gynecology, Frankfurt University Hospital, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Johannes Fleckenstein
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Pain Center, Hospital Landsberg am Lech, Landsberg am Lech, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University Frankfurt, Frankfurt/Main, Germany
| | - Andreas A Schnitzbauer
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
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Melnikova EA, Starkova EY, Semenkov AV, Litau VY, Tulskih DA. [Pre-rehabilitation of oncological patients before extensive abdominal and thoracic surgery: a literature review]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2024; 101:46-56. [PMID: 38639151 DOI: 10.17116/kurort202410102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Surgery is one of the leading treatment methods of patients with primary or recurrent malignant neoplasms in the thoracic or abdominal cavity. Extensive abdominal interventions are accompanied by such adverse outcomes as blood loss, hypoxia, inflammation, blood clotting abnormality, emotional and cognitive disorders, that increases the incidence of serious complications and worsens the treatment outcome and life quality in weakened oncological patients. Multimodal pre-rehabilitation before surgery can significantly decrease the incidence and severity of postoperative complications. The rehabilitation complex includes exercise therapy, nutritional and psychological support, smoking cessation and pharmacotherapy. Currently, there are a number of questions facing rehabilitation specialists and oncologists, that are related to the determination of pre-rehabilitation optimal timing and process duration, the choice of specific physical exercises, determining the load intensity. This review presents a current view on understanding of surgical stress in extensive abdominal interventions, its effect on the oncological process course, summarizes the experience of last years in choosing pre-rehabilitation program taking into account pathogenetic mechanisms of surgical stress and individual patient's characteristics. Special attention is paid to the comparison of physical exercises' various types, their action mechanisms at different stages of pathological process, the issues of load dosing during pre-rehabilitation activities.
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Affiliation(s)
- E A Melnikova
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - E Yu Starkova
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A V Semenkov
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - V Yu Litau
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - D A Tulskih
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
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Schnitzbauer AA, Zmuc D, Fleckenstein J. Digital prehabilitation-a solution to resource shortages? Lancet Digit Health 2024; 6:e11. [PMID: 38123251 DOI: 10.1016/s2589-7500(23)00247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Andreas A Schnitzbauer
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main 60590, Germany.
| | - Dora Zmuc
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main 60590, Germany
| | - Johannes Fleckenstein
- Institute of Sports Medicine, Goethe University Frankfurt am Main, Frankfurt am Main, Germany; Pain Center, Hospital Landsberg am Lech, Landsberg am Lech, Germany
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