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Crişan I, Slankamenac K, Bilotta F. How much does it cost to be fit for operation? The economics of prehabilitation. Curr Opin Anaesthesiol 2024; 37:171-176. [PMID: 38390954 DOI: 10.1097/aco.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW Prehabilitation before elective surgery can include physical, nutritional, and psychological interventions or a combination of these to allow patients to return postoperatively to baseline status as soon as possible. The purpose of this review is to analyse the current date related to the cost-effectiveness of such programs. RECENT FINDINGS The current literature regarding the economics of prehabilitation is limited. However, such programs have been mainly associated with either a reduction in total healthcare related costs or no increase. SUMMARY Prehabilitation before elective surgery has been shown to minimize the periprocedural complications and optimization of short term follow up after surgical procedures. Recent studies included cost analysis, either based on hospital accounting data or on estimates costs. The healthcare cost was mainly reduced by shortening the number of hospitalization day. Other factors included length of ICU stay, place of the prehabilitation program (in-hospital vs. home-based) and compliance to the program.
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Affiliation(s)
- Iulia Crişan
- Department of Emergency Medicine, University Hospital of Zürich, Zürich, Switzerland
| | - Ksenija Slankamenac
- Department of Emergency Medicine, University Hospital of Zürich, Zürich, Switzerland
| | - Federico Bilotta
- Department of Anestheisology, Critical care and Pain Medicine, University of Rome 'La Sapienza', Rome, Italy
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McIsaac DI, Fergusson DA, Khadaroo R, Meliambro A, Muscedere J, Gillis C, Hladkowicz E, Taljaard M. PREPARE trial: a protocol for a multicentre randomised trial of frailty-focused preoperative exercise to decrease postoperative complication rates and disability scores. BMJ Open 2022; 12:e064165. [PMID: 35940835 PMCID: PMC9364396 DOI: 10.1136/bmjopen-2022-064165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Frailty is a strong predictor of adverse postoperative outcomes. Prehabilitation may improve outcomes after surgery for older people with frailty by addressing physical and physiologic deficits. The objective of this trial is to evaluate the efficacy of home-based multimodal prehabilitation in decreasing patient-reported disability and postoperative complications in older people with frailty having major surgery. METHODS AND ANALYSIS We will conduct a multicentre, randomised controlled trial of home-based prehabilitation versus standard care among consenting patients >60 years with frailty (Clinical Frailty Scale>4) having elective inpatient major non-cardiac, non-neurologic or non-orthopaedic surgery. Patients will be partially blinded; clinicians and outcome assessors will be fully blinded. The intervention consists of >3 weeks of prehabilitation (exercise (strength, aerobic and stretching) and nutrition (advice and protein supplementation)). The study has two primary outcomes: in-hospital complications and patient-reported disability 30 days after surgery. Secondary outcomes include survival, lower limb function, quality of life and resource utilisation. A sample size of 750 participants (375 per arm) provides >90% power to detect a minimally important absolute difference of 8 on the 100-point patient-reported disability scale and a 25% relative risk reduction in complications, using a two-sided alpha value of 0.025 to account for the two primary outcomes. Analyses will follow intention to treat principles for all randomised participants. All participants will be followed to either death or up to 1 year. ETHICS AND DISSEMINATION Ethical approval has been granted by Clinical Trials Ontario (Project ID: 1785) and our ethics review board (Protocol Approval #20190409-01T). Results will be disseminated through presentation at scientific conferences, through peer-reviewed publication, stakeholder organisations and engagement of social and traditional media. TRIAL REGISTRATION NUMBER NCT04221295.
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Affiliation(s)
- Daniel I McIsaac
- Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rachel Khadaroo
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Meliambro
- Patient Engagement, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | | | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Emily Hladkowicz
- Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Franssen RFW, Bongers BC, Vogelaar FJ, Janssen-Heijnen MLG. Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study. Perioper Med (Lond) 2022; 11:28. [PMID: 35879732 PMCID: PMC9313601 DOI: 10.1186/s13741-022-00260-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Prehabilitation appears to be an effective strategy to reduce postoperative complications and enhance recovery after colorectal surgery. Although many patients prefer (unsupervised) home-based prehabilitation, adherence can be problematic. Combining home-based prehabilitation with tele-monitoring might demonstrate a higher adherence than unsupervised prehabilitation; however, evidence on its feasibility and effectiveness in patients with colorectal cancer scheduled for elective surgery who are at high risk for postoperative complications is lacking. The aim of this study was to assess the feasibility of a bimodal tele-prehabilitation program in patients with colorectal cancer at high risk for postoperative complications. Methods High-risk patients (oxygen uptake at the ventilatory anaerobic threshold ≤11 mL/kg/min or oxygen uptake at peak exercise ≤ 18 mL/kg/min) with colorectal cancer were included in a home-based bimodal tele-prehabilitation program. The program consisted of a personalized tele-monitored moderate to high-intensity interval training intervention and nutritional counseling. Feasibility was measured by participation rate, dropout rate, adherence to the physical exercise training session’s frequency, intensity, and time, and retention rate. Patient appreciation was measured by a patient appreciation questionnaire. Changes in preoperative physical fitness as secondary outcomes were quantified by time to exhaustion on a constant work rate (cycle) test, number of repetitions on the 30-s chair-stand test, and walking speed on the 4-m gait speed test. Results The participation rate was 81%, there were no adverse events, and all participants managed to complete the tele-prehabilitation program (retention rate of 100%). Adherence with regard to the exercise program’s frequency, intensity, and time was respectively 91%, 84%, and 100%. All participants appreciated the tele-prehabilitation program. Time to exhaustion on the constant work rate test improved (not statistically significant) from a pre-prehabilitation median score of 317 seconds to a post-prehabilitation median score of 412 seconds (p = 0.24). Median number of repetitions on the 30-s chair-stand test improved from 12 to 16 (p = 0.01). Conclusions Tele-prehabilitation seems feasible in high-risk patients with colorectal cancer, but efforts should be made to further improve adherence to physical exercise training intensity. More research is needed to establish the (cost-)effectiveness of tele-prehabilitation regarding preoperative improvements in preoperative aerobic fitness and postoperative reduction of complications. Trial registration ISRCTN, ISRCTN64482109. Registered 09 November 2021 - Retrospectively registered.
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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210 5912BL, 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.
| | - 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
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, 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
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Michel A, Gremeaux V, Muff G, Pache B, Geinoz S, Larcinese A, Benaim C, Kayser B, Demartines N, Hübner M, Martin D, Besson C. Short term high-intensity interval training in patients scheduled for major abdominal surgery increases aerobic fitness. BMC Sports Sci Med Rehabil 2022; 14:61. [PMID: 35392968 PMCID: PMC8991597 DOI: 10.1186/s13102-022-00454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022]
Abstract
Background Prehabilitation may improve postoperative clinical outcomes among patients undergoing major abdominal surgery. This study evaluated the potential effects of a high-intensity interval training (HIIT) program performed before major abdominal surgery on patients’ cardiorespiratory fitness and functional ability (secondary outcomes of pilot trial NCT02953119). Methods Patients were included before surgery to engage in a low-volume HIIT program with 3 sessions per week for 3 weeks. Cardiopulmonary exercise and 6-min walk (6MWT) testing were performed pre- and post-prehabilitation. Results Fourteen patients completed an average of 8.6 ± 2.2 (mean ± SD) sessions during a period of 27.9 ± 6.1 days. After the program, \documentclass[12pt]{minimal}
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\begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O2 peak (+ 2.4 ml min−1 kg−1, 95% CI 0.8–3.9, p = 0.006), maximal aerobic power (+ 16.8 W, 95% CI 8.2–25.3, p = 0.001), \documentclass[12pt]{minimal}
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\begin{document}$$\dot{\mathrm{V}}$$\end{document}V˙O2 at anaerobic threshold (+ 1.2 ml min−1 kg−1, 95%CI 0.4–2.1, p = 0.009) and power at anaerobic threshold (+ 12.4 W, 95%CI 4.8–20, p = 0.004) were improved. These changes were not accompanied by improved functional capacity (6MWT: + 2.6 m, 95% CI (− 19.6) to 24.8, p = 0.800). Conclusion A short low-volume HIIT program increases cardiorespiratory fitness but not walking capacity in patients scheduled for major abdominal surgery. These results need to be confirmed by larger studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00454-w.
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Affiliation(s)
- Anna Michel
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Vincent Gremeaux
- Department of Sports Medicine, Swiss Olympic Medical Center, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.,Institute of Sport Sciences, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Guillaume Muff
- Department of Physical Medicine and Rehabilitation, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Basile Pache
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sandrine Geinoz
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Ana Larcinese
- Department of Physiotherapy, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Charles Benaim
- Department of Physical Medicine and Rehabilitation, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - David Martin
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Cyril Besson
- Department of Sports Medicine, Swiss Olympic Medical Center, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.,Institute of Sport Sciences, University of Lausanne (UNIL), Lausanne, Switzerland
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Woodfield JC, Clifford K, Wilson GA, Munro F, Baldi JC. Short-term High-Intensity Interval Training Improves Fitness Before Surgery: A Randomised Clinical Trial. Scand J Med Sci Sports 2022; 32:856-865. [PMID: 35088469 PMCID: PMC9306492 DOI: 10.1111/sms.14130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Improving cardiopulmonary reserve, or peak oxygen consumption( V ˙ O2peak ), may reduce postoperative complications, however this may be difficult to achieve between diagnosis and surgery. Our primary aim was to assess the efficacy of an approximate 14-session, preoperative High Intensity Interval Training(HIIT) program to increase V ˙ O2peak by a clinically-relevant 2 mL·kg-1 ·min-1 . Our secondary aim was to document clinical outcomes. METHODOLOGY In this prospective study, participants aged 45-85 undergoing major abdominal surgery were randomised to standard care or 14 sessions of HIIT over 4 weeks. HIIT sessions involved approximately thirty minutes of stationary cycling. Interval training alternated one minute of high (with the goal of reaching 90% max heart rate at least once during the session) and low/moderate intensity cycling. Cardiopulmonary exercise testing(CPET) measured the change in V ˙ O2peak from baseline to surgery. Clinical outcomes included postoperative complications, length of stay(LOS) and Short Form-36 quality of life questionnaire(SF-36). RESULTS Of 63 participants, 46 completed both CPETs and 50 completed clinical follow-up. There was a significant improvement in the HIIT group's mean ± SD V ˙ O2peak (HIIT 2.87 ± 1.94 mL·kg1 ·min-1 vs standard care 0.15 ± 1.93, with an overall difference of 2.73 mL·kg1 ·min-1 95%CI [1.53, 3.93] p<0.001). There were no statistically significant differences between groups for clinical outcomes, although the observed differences consistently favoured the exercise group. This was most notable for total number of complications (0.64 v 1.16 per patient, p=0.07), SF-36 physical component score (p=0.06), and LOS (mean 5.5 v 7.4 days, p=0.07). CONCLUSIONS There was a significant improvement in V ˙ O2peak with a four-week preoperative HIIT program. Further appropriately-powered work is required to explore the impact of preoperative HIIT on postoperative clinical outcomes.
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Affiliation(s)
- John C Woodfield
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago
| | - Kari Clifford
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago
| | | | - Fran Munro
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago
| | - James C Baldi
- Department of Medicine, Dunedin School of Medicine, University of Otago
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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.
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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
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Rose GA, Adamson MJ, Davies RG, Appadurai IR, Bailey DM. High-intensity exercise training improves perioperative risk stratification in the high-risk patient. Physiol Rep 2021; 8:e14409. [PMID: 32378338 PMCID: PMC7202981 DOI: 10.14814/phy2.14409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/22/2023] Open
Abstract
Exercise prehabilitation prior to major surgery can improve cardiorespiratory fitness (CRF) and clinical outcome. However, in patients deemed “high‐‐risk” for surgery, the feasibility, optimum training modality and its intensity, duration, and frequency are yet to be defined. We assessed the cardiorespiratory fitness of a 70‐year‐old female patient requiring major thoraco‐abdominal surgery for reconstruction of her esophagus. Cardiopulmonary exercise testing (CPET) on a cycle ergometer was used to determine CRF. A baseline CPET confirmed poor CRF and placed her in a high surgical risk group. This was followed by 16 weeks of unsupervised, home‐based, moderate‐intensity steady‐state (MISS) training followed by 10 weeks of high‐intensity interval training (HIIT) under the combined supervision of an exercise physiologist and clinician in hospital. Following MISS training, CPET metrics failed to improve: peak oxygen uptake decreased (14.7–13.7 ml O2·kg−1·min−1; −7%) together with peak power (73–70 W; −4%) and anaerobic threshold (AT) increased (7.8–8.3 ml O2·kg−1·min−1; +6%). However, HIIT resulted in impressive improvement in CRF. Peak oxygen uptake (13.7–18.6 ml O2·kg−1·min−1; +36%), AT (8.3–10.5 ml O2·kg−1·min−1; +27%), peak power (70–102 W; +46%), minute ventilation (35.8–57.7 L·min−1; +61%), and peak heart rate (100–133 b·min−1; +33%) all increased. Ventilatory equivalents for carbon dioxide at AT (V˙E/V˙CO2‐AT) improved (30–28; −7%). The improvement in CRF resulted in surgical reclassification from high to low risk. In conclusion, preoperative HIIT training can confer a marked improvement in CRF in an elderly surgical patient and is associated with a corresponding reduction in perioperative risk.
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Affiliation(s)
- George A Rose
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Michael J Adamson
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - Richard G Davies
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - Ian R Appadurai
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - Damian M Bailey
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Prehabilitation before major intra-abdominal cancer surgery: A systematic review of randomised controlled trials. Eur J Anaesthesiol 2020; 36:933-945. [PMID: 31188152 PMCID: PMC6855314 DOI: 10.1097/eja.0000000000001030] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Supplemental Digital Content is available in the text BACKGROUND Although prehabilitation programmes for patients undergoing major intra-abdominal cancer surgery have been shown to improve pre-operative physical fitness, the conclusions regarding any postoperative benefits are inconsistent. OBJECTIVES The aim of this study was to evaluate the content of and the outcome measures used in studies of prehabilitation programmes for these patients. It was hypothesised that the content of prehabilitation programmes is often therapeutically invalid, and that the postoperative outcomes assessed are inadequate to evaluate the impact of complications. DESIGN A systematic review of randomised controlled trials. DATA SOURCES Studies published between January 2009 and January 2019 were retrieved from PubMed, Embase and PEDro. ELIGIBILITY CRITERIA Studies were included when they investigated the effects of prehabilitation in patients undergoing intra-abdominal surgery for cancer, reported pre-operative and/or postoperative outcome measures and were conducted as a randomised controlled trial. Studies for which the full text was not available were excluded, as were studies of patients undergoing nonabdominal cancer surgery. RESULTS Eight studies (565 patients) were included. Therapeutic validity was low in five studies. Most studies included low-risk surgical patients and considerable variation was observed between prehabilitation programmes in terms of supervision, training context, frequency, intensity, duration and training type. Objective monitoring of training progression was typically not performed, and most trials did not include nutritional or psychological support. Postoperative complications were reported in seven studies, but no study reported the impact of postoperative complications, nor on long-term postoperative outcomes. CONCLUSION The content of prehabilitation programmes was heterogeneous. Studies with a high therapeutic validity found unequivocal evidence that prehabilitation had beneficial effects on postoperative outcomes. Future research should focus on adequate selection and inclusion of high-risk surgical patients and provide personalised and probably multimodal (partly) supervised prehabilitation, with objective monitoring of progress. Measuring the incidence and impact of postoperative complications may contribute to demonstrating the clinical value of prehabilitation.
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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.
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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.
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Molenaar CJL, Papen-Botterhuis NE, Herrle F, Slooter GD. Prehabilitation, making patients fit for surgery - a new frontier in perioperative care. Innov Surg Sci 2019; 4:132-138. [PMID: 33977122 PMCID: PMC8059351 DOI: 10.1515/iss-2019-0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Abstract
Optimizing a patients’ condition before surgery to improve the postoperative outcome can be achieved by using prehabilitation; preoperative interventions focusing on modifiable risk factors to improve the physical, nutritional, and mental status of the patient. A multimodal, multidisciplinary approach induces a synergistic effect between the various interventions and affects the outcome postoperatively. While awaiting higher-quality evidence, the worldwide implementation of prehabilitation programs has started, resulting in a true revolution in perioperative care.
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Affiliation(s)
| | | | - Florian Herrle
- Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Gerrit D Slooter
- Department of Surgical Oncology, Máxima MC, 5500MB, Veldhoven, the Netherlands, E-mail:
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Woodfield JC, Baldi JC, Clifford K. What is the minimal dose of HIIT required to achieve pre-operative benefit. Scand J Med Sci Sports 2019; 29:1841. [PMID: 31408549 DOI: 10.1111/sms.13538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/08/2019] [Indexed: 12/26/2022]
Affiliation(s)
- John C Woodfield
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James C Baldi
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kari Clifford
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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