PreScheck Team Study: prehabilitation clinic as an effective patient management tool in elective cardiac surgery

INTRODUCTION

The main purpose of the study was to assess the impact of preoperative interdisciplinary assessment by the PreScheck Team on optimization of the final selection for elective cardiac surgery.

MATERIAL AND METHODS

This is a single-centre prospective observational study. The examined population consisted of 933 adult patients planned for cardiac surgery. After the exclusion of urgent operations, the study group consisted of 288 patients planned for elective cardiac surgery within 3 months from 1.01.2023 with PreScheck assessment (PreScheck Team group 2) and a control group of 311 patients scheduled for elective cardiac surgery between 1.03.2022 and 30.06.2022 (4 months), without preoperative interdiscipli-nary assessment (No PreScheck Team group 2).

RESULTS

Fifty-two patients (18.06%) from the study group were finally excluded from the surgery on the scheduled date. In 46 patients (88.46%) the temporary or permanent exclusion from surgery was a result of PreScheck Team assessment. In the control group 42 patients (13.5%) did not undergo surgery on the scheduled date. Twenty-seven of those patients (8.97%) were permanently excluded from cardiac surgery after admission to the hospital and required additional tests before the final clinical decision, with total hospitalization time of 146 days.

CONCLUSIONS

Pre Surgery Check (PreScheck) Team is an original concept that combines classical preoperative assessment and an outpatient prehabilitation clinic. The approach we are proposing here should be a complementary stage in the process of selection for elective cardiac surgery, in addition to the Heart Team recommendation. This two-step decision-making enables real individual risk assessment, selection of the most suitable intervention and better use of medical resources.

Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery

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.

Problems and challenges in the early period of rehabilitating patients with severe hypothermia treated using ecmo support

The objectives: To show and discuss the most frequent functional problems encountered in patients who underwent extracorporeal membrane oxygenation (ECMO) treatment after severe hypothermia and point out appropriate physiotherapy procedures used in order to diminish the effects of hypothermia on the human organism. It is necessary to look for effective physiotherapeutic solutions, especially that the number of scientific publications on the subject is very limited.

DESIGN

Retrospective analysis Setting: Severe Accidental Hypothermia Center ( medical intensive care unit of a university hospital) Patients or participants: Nineteen patients who were qualified for ECMO in Severe Accidental Hypothermia Center Intervention: At least three times a day rehabilitation session (physiotherapeutic procedures adequate to patient problems) and interventions in case of emergency. Physiotherapy staff in the Center has regular work hours and night duties, so can provide round-the clock rehabilitation treatment adjusted to the dynamically changing clinical picture of the patient.

METHODS AND RESULTS

We analyzed the group of patients who were treated in our center from July 2013 to March 2015. The degree of functional complications increased with the duration and extent of hypothermia and time of conducting extracorporeal therapy. The frequent problems were: respiratory failure due to sputum retention (25%) or sternum fracture due to resuscitation (25%), lower and upper extremity muscle weakening (75%), peroneal nerve palsy (25%). In the first period of hospitalization all of patients have generalised edema. As a result of the treatment and rehabilitation, full stabilization of the cardiovascular - respiratory system and full recovery of neurological functions was achieved in 14 persons (73.68%).

CONCLUSION

early and round-the clock physiotherapy treatment adequate to appearing patient's syndromes seems crucial for his physical and mental recovery after severe accidental hypothermia treated by ECMO support. In order to attain therapeutic success, it is indispensable to work in experienced, multidisciplinary team.

Problems and challenges in the early period of rehabilitating patients with severe hypothermia treated using ecmo support

The objectives: To show and discuss the most frequent functional problems encountered in patients who underwent extracorporeal membrane oxygenation (ECMO) treatment after severe hypothermia and point out appropriate physiotherapy procedures used in order to diminish the effects of hypothermia on the human organism. It is necessary to look for effective physiotherapeutic solutions, especially that the number of scientific publications on the subject is very limited.

DESIGN

Retrospective analysis Setting: Severe Accidental Hypothermia Center ( medical intensive care unit of a university hospital) Patients or participants: Nineteen patients who were qualified for ECMO in Severe Accidental Hypothermia Center Intervention: At least three times a day rehabilitation session (physiotherapeutic procedures adequate to patient problems) and interventions in case of emergency. Physiotherapy staff in the Center has regular work hours and night duties, so can provide round-the clock rehabilitation treatment adjusted to the dynamically changing clinical picture of the patient.

METHODS AND RESULTS

We analyzed the group of patients who were treated in our center from July 2013 to March 2015. The degree of functional complications increased with the duration and extent of hypothermia and time of conducting extracorporeal therapy. The frequent problems were: respiratory failure due to sputum retention (25%) or sternum fracture due to resuscitation (25%), lower and upper extremity muscle weakening (75%), peroneal nerve palsy (25%). In the first period of hospitalization all of patients have generalised edema. As a result of the treatment and rehabilitation, full stabilization of the cardiovascular - respiratory system and full recovery of neurological functions was achieved in 14 persons (73.68%).

CONCLUSION

early and round-the clock physiotherapy treatment adequate to appearing patient's syndromes seems crucial for his physical and mental recovery after severe accidental hypothermia treated by ECMO support. In order to attain therapeutic success, it is indispensable to work in experienced, multidisciplinary team.