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For: Jack S, West M, Grocott MPW. Perioperative exercise training in elderly subjects. Best Pract Res Clin Anaesthesiol 2011;25:461-72. [PMID: 21925410 DOI: 10.1016/j.bpa.2011.07.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/12/2011] [Indexed: 01/27/2023]

For:	Jack S, West M, Grocott MPW. Perioperative exercise training in elderly subjects. Best Pract Res Clin Anaesthesiol 2011;25:461-72. [PMID: 21925410 DOI: 10.1016/j.bpa.2011.07.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/12/2011] [Indexed: 01/27/2023]

Number

Cited by Other Article(s)

Li S, Fang M, Yin R, Wang Y, Chen R, Wang C, Li K, Shi W, Tang ST. Enhanced recovery after minimally invasive pneumonectomies in children. Pediatr Surg Int 2025;41:81. [PMID: 39955421 DOI: 10.1007/s00383-025-05977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2025] [Indexed: 02/17/2025]

Bolshinsky V, Ismail H, Li M, Basto J, Schier R, Hagemeier A, Ho KM, Heriot A, Riedel B. Clinical covariates that improve surgical risk prediction and guide targeted prehabilitation: an exploratory, retrospective cohort study of major colorectal cancer surgery patients evaluated with preoperative cardiopulmonary exercise testing. Perioper Med (Lond) 2022;11:20. [PMID: 35614461 PMCID: PMC9134693 DOI: 10.1186/s13741-022-00246-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 02/17/2022] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

Preoperative risk stratification is used to derive an optimal treatment plan for patients requiring cancer surgery. Patients with reversible risk factors are candidates for prehabilitation programmes. This pilot study explores the impact of preoperative covariates of comorbid disease (Charlson Co-morbidity Index), preoperative serum biomarkers, and traditional cardiopulmonary exercise testing (CPET)-derived parameters of functional capacity on postoperative outcomes after major colorectal cancer surgery.

METHODS

Consecutive patients who underwent CPET prior to colorectal cancer surgery over a 2-year period were identified and a minimum of 2-year postoperative follow-up was performed. Postoperative assessment included: Clavien-Dindo complication score, Comprehensive Complication Index, Days at Home within 90 days (DAH-90) after surgery, and overall survival.

RESULTS

The Charlson Co-morbidity Index did not discriminate postoperative complications, or overall survival. In contrast, low preoperative haemoglobin, low albumin, or high neutrophil count were associated with postoperative complications and reduced overall survival. CPET-derived parameters predictive of postoperative complications, DAH-90, and reduced overall survival included measures of VCO₂ kinetics at anaerobic threshold (AT), peakVO₂ (corrected to body surface area), and VO₂ kinetics during the post-exercise recovery phase. Inflammatory parameters and CO₂ kinetics added significant predictive value to peakVO₂ within bi-variable models for postoperative complications and overall survival (P < 0.0001).

CONCLUSION

Consideration of modifiable 'triple low' preoperative risk (anaemia, malnutrition, deconditioning) factors and inflammation will improve surgical risk prediction and guide prehabilitation. Gas exchange parameters that focus on VCO₂ kinetics at AT and correcting peakVO₂ to body surface area (rather than absolute weight) may improve CPET-derived preoperative risk assessment.

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Perry R, Herbert G, Atkinson C, England C, Northstone K, Baos S, Brush T, Chong A, Ness A, Harris J, Haase A, Shah S, Pufulete M. Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis. BMJ Open 2021;11:e050806. [PMID: 34593498 PMCID: PMC8487197 DOI: 10.1136/bmjopen-2021-050806] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open

Abstract

OBJECTIVE

To determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery.

DESIGN

Systematic review and meta-analysis of randomised controlled trials (RCTs) (published or unpublished). We searched Medline, Embase, CENTRAL, DARE, HTA and NHS EED, The Cochrane Library, CINAHL, PsychINFO and ISI Web of Science (June 2020).

SETTING

Secondary care.

PARTICIPANTS

Patients (≥18 years) undergoing major elective surgery (curative or palliative).

INTERVENTIONS

Any intervention administered in the preoperative period with the aim of improving postoperative outcomes.

OUTCOMES AND MEASURES

Primary outcomes were 30-day mortality, hospital length of stay (LoS) and postoperative complications. Secondary outcomes included LoS in intensive care unit or high dependency unit, perioperative morbidity, hospital readmission, postoperative pain, heath-related quality of life, outcomes specific to the intervention, intervention-specific adverse events and resource use.

REVIEW METHODS

Two authors independently extracted data from eligible RCTs and assessed risk of bias and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Random-effects meta-analyses were used to pool data across trials.

RESULTS

178 RCTs including eight types of intervention were included. Inspiratory muscle training (IMT), immunonutrition and multimodal interventions reduced hospital LoS (mean difference vs usual care: -1.81 days, 95% CI -2.31 to -1.31; -2.11 days, 95% CI -3.07 to -1.15; -1.67 days, 95% CI -2.31 to -1.03, respectively). Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications (RR 0.55, 95% CI 0.38 to 0.80, and RR 0.54, 95% CI 0.39 to 0.75, respectively). Smoking cessation interventions reduced wound infections (RR 0.28, 95% CI 0.12 to 0.64).

CONCLUSIONS

Some prehabilitation interventions may reduce postoperative LoS and complications but the quality of the evidence was low.

PROSPERO REGISTRATION NUMBER

CRD42015019191.

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Blackwell JEM, Gharahdaghi N, Brook MS, Watanabe S, Boereboom CL, Doleman B, Lund JN, Wilkinson DJ, Smith K, Atherton PJ, Williams JP, Phillips BE. The physiological impact of high-intensity interval training in octogenarians with comorbidities. J Cachexia Sarcopenia Muscle 2021;12:866-879. [PMID: 34060253 PMCID: PMC8350218 DOI: 10.1002/jcsm.12724] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 12/18/2022] Open

Abstract

BACKGROUND

Declines in cardiorespiratory fitness (CRF) and fat-free mass (FFM) with age are linked to mortality, morbidity and poor quality of life. High-intensity interval training (HIIT) has been shown to improve CRF and FFM in many groups, but its efficacy in the very old, in whom comorbidities are present is undefined. We aimed to assess the efficacy of and physiological/metabolic responses to HIIT, in a cohort of octogenarians with comorbidities (e.g. hypertension and osteoarthritis).

METHODS

Twenty-eight volunteers (18 men, 10 women, 81.2 ± 0.6 years, 27.1 ± 0.6 kg·m^-2 ) with American Society of Anaesthesiology (ASA) Grade 2-3 status each completed 4 weeks (12 sessions) HIIT after a control period of equal duration. Before and after each 4 week period, subjects underwent body composition assessments and cardiopulmonary exercise testing. Quadriceps muscle biopsies (m. vastus lateralis) were taken to quantify anabolic signalling, mitochondrial oxidative phosphorylation, and cumulative muscle protein synthesis (MPS) over 4-weeks.

RESULTS

In comorbid octogenarians, HIIT elicited improvements in CRF (anaerobic threshold: +1.2 ± 0.4 ml·kg^-1 ·min^-1 , P = 0.001). HIIT also augmented total FFM (47.2 ± 1.4 to 47.6 ± 1.3 kg, P = 0.04), while decreasing total fat mass (24.8 ± 1.3 to 24 ± 1.2 kg, P = 0.0002) and body fat percentage (33.1 ± 1.5 to 32.1 ± 1.4%, P = 0.0008). Mechanistically, mitochondrial oxidative phosphorylation capacity increased after HIIT (i.e. citrate synthase activity: 52.4 ± 4 to 67.9 ± 5.1 nmol·min^-1 ·mg^-1 , P = 0.005; membrane protein complexes (C): C-II, 1.4-fold increase, P = 0.002; C-III, 1.2-fold increase, P = 0.03), as did rates of MPS (1.3 ± 0.1 to 1.5 ± 0.1%·day^-1 , P = 0.03). The increase in MPS was supported by up-regulated phosphorylation of anabolic signalling proteins (e.g. AKT, p70S6K, and 4E-BP1; all P < 0.05). There were no changes in any of these parameters during the control period. No adverse events were reported throughout the study.

CONCLUSIONS

The HIIT enhances skeletal muscle mass and CRF in octogenarians with disease, with up-regulation of MPS and mitochondrial capacity likely underlying these improvements. HIIT can be safely delivered to octogenarians with disease and is an effective, time-efficient intervention to improve muscle mass and physical function in a short time frame.

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Affiliation(s)

James E M Blackwell MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,Department of Surgery & Anaesthetics, Royal Derby Hospital, Derby, UK
Nima Gharahdaghi MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute of Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), Nottingham, UK
Matthew S Brook MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute of Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), Nottingham, UK
Shinya Watanabe MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK
Catherine L Boereboom MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK
Brett Doleman Department of Surgery & Anaesthetics, Royal Derby Hospital, Derby, UK
Jonathan N Lund MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,Department of Surgery & Anaesthetics, Royal Derby Hospital, Derby, UK
Daniel J Wilkinson MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute of Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), Nottingham, UK
Kenneth Smith MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute of Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), Nottingham, UK
Philip J Atherton MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute of Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), Nottingham, UK
John P Williams MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,Department of Surgery & Anaesthetics, Royal Derby Hospital, Derby, UK
Bethan E Phillips MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute of Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), Nottingham, UK

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Lambert JE, Hayes LD, Keegan TJ, Subar DA, Gaffney CJ. The Impact of Prehabilitation on Patient Outcomes in Hepatobiliary, Colorectal, and Upper Gastrointestinal Cancer Surgery: A PRISMA-Accordant Meta-analysis. Ann Surg 2021;274:70-77. [PMID: 33201129 DOI: 10.1097/sla.0000000000004527] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Abstract

OBJECTIVE

To determine the impact of prehabilitation on hospital length of stay, functional capacity, complications, and mortality after surgery in patients with hepatobiliary, colorectal, and upper gastrointestinal cancer.

BACKGROUND

"Prehabilitation" encompasses exercise, nutrition, and psychosocial interventions to optimize health before surgery. The benefits of prehabilitation are ill-defined.

METHODS

Medline, Embase and Cochrane Databases were searched systematically for the terms "prehabilitation AND exercise," "perioperative care AND cancer surgery," and "colorectal AND hepatobiliary AND hepatopancreatobiliary AND esophagogastric AND recovery AND outcomes." Primary outcomes analyzed were hospital length of stay, functional capacity, significant postoperative complications (Clavien Dindo ≥ III), and mortality. A meta-analysis was conducted on the effect of all-modality prehabilitation for patients with colorectal, hepatopancreatobiliary and upper gastrointestinal cancer surgery using the raw mean difference, risk difference, and a random-effects model.

RESULTS

Three hundred and seventy seven original titles were identified. Fifteen studies (randomized controlled trials; n = 9 and uncontrolled trials; n = 6) were included in the meta-analysis. Prehabilitation reduced hospital length of stay by 1.78 days versus standard care (95% CI: -3.36, -0.20, P < 0.05). There was no significant difference in functional capacity with prehabilitation determined using the 6-minute walk test (P = 0.816) and no significant reduction in postoperative complications (P = 0.378) or mortality rates (P = 0.114).

CONCLUSIONS

Prehabilitation was associated with reduced hospital length of stay but had no effect on functional capacity, postoperative complications, or mortality rates. Thus, prehabilitation should be recommended to accelerate recovery from cancer surgery, demonstrated by reduced hospital length of stay.

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Swallowing Exercise During Head and Neck Cancer Treatment: Results of a Randomized Trial. Dysphagia 2021;37:749-762. [PMID: 34117531 PMCID: PMC9345844 DOI: 10.1007/s00455-021-10320-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/13/2021] [Indexed: 11/25/2022]

Myers J, Niebauer J, Humphrey R. Prehabilitation Coming of Age: IMPLICATIONS FOR CARDIAC AND PULMONARY REHABILITATION. J Cardiopulm Rehabil Prev 2021;41:141-146. [PMID: 33512981 DOI: 10.1097/hcr.0000000000000574] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]

Abstract

While cardiac and pulmonary rehabilitation programs traditionally involve exercise therapy and risk management following an event (eg, myocardial infarction and stroke), or an intervention (eg, coronary artery bypass surgery and percutaneous coronary intervention), prehabilitation involves enhancing functional capacity and optimizing risk profile prior to a scheduled intervention. The concept of prehabilitation is based on the principle that patients with higher functional capabilities will better tolerate an intervention, and will have better pre- and post-surgical outcomes. In addition to improving fitness, prehabilitation has been extended to include multifactorial risk intervention prior to surgery, including psychosocial counseling, smoking cessation, diabetes control, nutrition counseling, and alcohol abstinence. A growing number of studies have shown that patients enrolled in prehabilitation programs have reduced post-operative complications and demonstrate better functional, psychosocial, and surgery-related outcomes. These studies have included interventions such as hepatic transplantation, lung cancer resection, and abdominal aortic aneurysm (repair, upper gastrointestinal surgery, bariatric surgery, and coronary artery bypass grafting). Studies have also suggested that incorporation of prehabilitation before an intervention in addition to traditional rehabilitation following an intervention further enhances physical function, lowers risk for adverse events, and better prepares a patient to resume normal activities, including return to work. In this overview, we discuss prehabilitation coming of age, including key elements related to optimizing pre-surgical fitness, factors to consider in developing a prehabilitation program, and exercise training strategies to improve pre-surgical fitness.

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Yau DKW, Underwood MJ, Joynt GM, Lee A. Effect of preparative rehabilitation on recovery after cardiac surgery: A systematic review. Ann Phys Rehabil Med 2021;64:101391. [PMID: 32446762 DOI: 10.1016/j.rehab.2020.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/14/2020] [Accepted: 03/30/2020] [Indexed: 12/29/2022]

Abstract

BACKGROUND

Physical prehabilitation (preparative rehabilitation) programs may have beneficial effects on enhancing physical strength and functional status before surgery, but their effects on postoperative recovery are unclear.

OBJECTIVES

This systematic review investigated the effectiveness of physical prehabilitation programs before cardiac surgery on postoperative recovery and other perioperative outcomes.

METHODS

We searched for reports of randomised controlled trials of any prehabilitation programs that included physical activity or an exercise training component in adults undergoing elective cardiac surgery, published in any language, from six bibliographic databases (last search on June 20, 2019). We assessed trials for risk of bias, overall certainty of evidence and quality of intervention reporting using the Cochrane Risk of Bias Assessment Tool, GRADE system and the Template for Intervention Description and Replication checklist and guide, respectively.

RESULTS

All 7 studies (726 participants) were at high risk of bias because of lack of blinding. The quality of prehabilitation reporting was moderate because program adherence was rarely assessed. The timing of prehabilitation ranged from 5 days to 16 weeks before surgery and from face-to-face exercise prescription to telephone counselling and monitoring. We found uncertain effects of prehabilitation on postoperative clinical outcomes (among the many outcomes assessed): perioperative mortality (Peto odds ratio 1.30, 95% confidence interval [CI] 0.28 to 5.95; I2=0%; low-certainty evidence) and postoperative atrial fibrillation (relative risk 0.75, 95% CI 0.38 to 1.46; I2=50%; very low-certainty evidence). However, prehabilitation may improve postoperative functional capacity and slightly shorten the hospital stay (mean difference -0.66 days, 95% CI -1.29 to -0.03; I2=45%; low-certainty evidence).

CONCLUSION

Despite the high heterogeneity among physical prehabilitation trials and the uncertainty regarding robust clinical outcomes, physical prehabilitation before cardiac surgery seems to enhance selected postoperative functional performance measures and slightly reduce the hospital length of stay after cardiac surgery.

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Guida JL, Agurs-Collins T, Ahles TA, Campisi J, Dale W, Demark-Wahnefried W, Dietrich J, Fuldner R, Gallicchio L, Green PA, Hurria A, Janelsins MC, Jhappan C, Kirkland JL, Kohanski R, Longo V, Meydani S, Mohile S, Niedernhofer LJ, Nelson C, Perna F, Schadler K, Scott JM, Schrack JA, Tracy RP, van Deursen J, Ness KK. Strategies to Prevent or Remediate Cancer and Treatment-Related Aging. J Natl Cancer Inst 2021;113:112-122. [PMID: 32348501 PMCID: PMC7850536 DOI: 10.1093/jnci/djaa060] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open

Affiliation(s)

Jennifer L Guida Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
Tanya Agurs-Collins Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
Tim A Ahles Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Judith Campisi Buck Institute for Research on Aging, Novato, CA, USA Lawrence Berkeley National Laboratory, Berkeley, CA, USA
William Dale City of Hope, Duarte, CA, USA
Wendy Demark-Wahnefried Department of Nutrition Sciences, University of Alabama, Birmingham, AL, USA
Jorg Dietrich Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
Rebecca Fuldner Division of Aging Biology, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
Lisa Gallicchio Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
Paige A Green Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
Arti Hurria City of Hope, Duarte, CA, USA
Michelle C Janelsins Department of Surgery and Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
Chamelli Jhappan Division of Cancer Biology, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
James L Kirkland Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
Ronald Kohanski Division of Aging Biology, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
Valter Longo University of Southern California, Los Angeles, California, USA IFOM Institute, Milan, Italy
Simin Meydani Jean Mayer USDA Human Nutritional Research Center on Aging, Tufts University, Boston, MA, USA
Supriya Mohile Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
Laura J Niedernhofer Department of Biochemistry, Molecular Biology, and Biophysics, Institute on the Biology of Aging and Metabolism, University of Minnesota, Minneapolis, MN, USA
Christian Nelson Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Frank Perna Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
Keri Schadler Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
Jessica M Scott Memorial Sloan Kettering Cancer Center, New York, NY, USA
Jennifer A Schrack Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Russell P Tracy Departments of Pathology & Laboratory Medicine, and Biochemistry, Larner College of Medicine, University of Vermont, Colchester, VT, USA
Jan van Deursen Mayo Clinic, Rochester, MN, USA
Kirsten K Ness Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA

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Daniels SL, Lee MJ, George J, Kerr K, Moug S, Wilson TR, Brown SR, Wyld L. Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis. BJS Open 2020;4:1022-1041. [PMID: 32959532 PMCID: PMC7709363 DOI: 10.1002/bjs5.50347] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022] Open

Abstract

BACKGROUND

Prehabilitation has emerged as a strategy to prepare patients for elective abdominal cancer surgery with documented improvements in postoperative outcomes. The aim of this study was to assess the evidence for prehabilitation interventions of relevance to the older adult.

METHODS

Systematic searches were conducted using MEDLINE, Web of Science, Scopus, CINAHL and PsychINFO. Studies of preoperative intervention (prehabilitation) in patients undergoing abdominal cancer surgery reporting postoperative outcomes were included. Age limits were not set as preliminary searches revealed this would be too restrictive. Articles were screened and selected based on PRISMA guidelines, and assessment of bias was performed. Qualitative, quantitative and meta-analyses of data were conducted as appropriate.

RESULTS

Thirty-three studies (3962 patients) were included. Interventions included exercise, nutrition, psychological input, comprehensive geriatric assessment and optimization, smoking cessation and multimodal (two or more interventions). Nine studies purposely selected high-risk, frail or older patients. Thirty studies were at moderate or high risk of bias. Ten studies individually reported benefits in complication rates, with meta-analyses for overall complications demonstrating significant benefit: multimodal (risk difference -0·1 (95 per cent c.i. -0·18 to -0·02); P = 0·01, I2 = 18 per cent) and nutrition (risk difference -0·18 (-0·26 to -0·10); P < 0·001, I2 = 0 per cent). Seven studies reported reductions in length of hospital stay, with no differences on meta-analysis.

CONCLUSION

The conclusions of this review are limited by the quality of the included studies, and the heterogeneity of interventions and outcome measures reported. Exercise, nutritional and multimodal prehabilitation may reduce morbidity after abdominal surgery, but data specific to older patients are sparse.

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Tully R, Loughney L, Bolger J, Sorensen J, McAnena O, Collins CG, Carroll PA, Arumugasamy M, Murphy TJ, Robb WB. The effect of a pre- and post-operative exercise programme versus standard care on physical fitness of patients with oesophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (The PERIOP-OG Trial): Study protocol for a randomised controlled trial. Trials 2020;21:638. [PMID: 32660526 PMCID: PMC7359259 DOI: 10.1186/s13063-020-04311-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/04/2020] [Indexed: 11/10/2022] Open

Abstract

BACKGROUND

Advances in peri-operative oncological treatment, surgery and peri-operative care have improved survival for patients with oesophagogastric cancers. Neoadjuvant cancer treatment (NCT) reduces physical fitness, which may reduce both compliance and tolerance of NCT as well as compromising post-operative outcomes. This is particularly detrimental in a patient group where malnutrition is common and surgery is demanding. The aim of this trial is to assess the effect on physical fitness and clinical outcomes of a comprehensive exercise training programme in patients undergoing NCT and surgical resection for oesophagogastric malignancies.

METHODS

The PERIOP-OG trial is a pragmatic, multi-centre, randomised controlled trial comparing a peri-operative exercise programme with standard care in patients with oesophagogastric cancers treated with NCT and surgery. The intervention group undergo a formal exercise training programme and the usual care group receive standard clinical care (no formal exercise advice). The training programme is initiated at cancer diagnosis, continued during NCT, between NCT and surgery, and resumes after surgery. All participants undergo assessments at baseline, post-NCT, pre-surgery and at 4 and 10 weeks after surgery. The primary endpoint is cardiorespiratory fitness measured by demonstration of a 15% difference in the 6-min walk test assessed at the pre-surgery timepoint. Secondary endpoints include measures of physical health (upper and lower body strength tests), body mass index, frailty, activity behaviour, psychological and health-related quality of life outcomes. Exploratory endpoints include a health economics analysis, assessment of clinical health by post-operative morbidity scores, hospital length of stay, nutritional status, immune and inflammatory markers, and response to NCT. Rates of NCT toxicity, tolerance and compliance will also be assessed.

DISCUSSION

The PERIOP-OG trial will determine whether, when compared to usual care, exercise training initiated at diagnosis and continued during NCT, between NCT and surgery and then during recovery, can maintain or improve cardiorespiratory fitness and other physical, psychological and clinical health outcomes. This trial will inform both the prescription of exercise regimes as well as the design of a larger prehabilitation and rehabilitation trial to investigate whether exercise in combination with nutritional and psychological interventions elicit greater benefits.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03807518 . Registered on 1 January 2019.

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Carli F, Baldini G. From preoperative assessment to preoperative optimization of frail older patiens. Eur J Surg Oncol 2020;47:519-523. [PMID: 32753116 DOI: 10.1016/j.ejso.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022] Open

Teja B, Raub D, Friedrich S, Rostin P, Patrocínio MD, Schneider JC, Shen C, Brat GA, Houle TT, Yeh RW, Eikermann M. Incidence, Prediction, and Causes of Unplanned 30-Day Hospital Admission After Ambulatory Procedures. Anesth Analg 2020;131:497-507. [DOI: 10.1213/ane.0000000000004852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Brown SA. Preventive Cardio-Oncology: The Time Has Come. Front Cardiovasc Med 2020;6:187. [PMID: 31998754 PMCID: PMC6965025 DOI: 10.3389/fcvm.2019.00187] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022] Open

Montroni I, Ugolini G, Audisio RA. Principles of Cancer Surgery in Older Adults. GERIATRIC ONCOLOGY 2020:825-844. [DOI: 10.1007/978-3-319-57415-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]

Raymond BL, Wanderer JP, Hawkins AT, Geiger TM, Ehrenfeld JM, Stokes JW, McEvoy MD. Use of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator During Preoperative Risk Discussion: The Patient Perspective. Anesth Analg 2019;128:643-650. [PMID: 30169413 DOI: 10.1213/ane.0000000000003718] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]

Abstract

BACKGROUND

The American College of Surgeons (ACS) National Surgical Quality Improvement Program Surgical Risk Calculator (ACS Calculator) provides empirically derived, patient-specific risks for common adverse perioperative outcomes. The ACS Calculator is promoted as a tool to improve shared decision-making and informed consent for patients undergoing elective operations. However, to our knowledge, no data exist regarding the use of this tool in actual preoperative risk discussions with patients. Accordingly, we performed a survey to assess (1) whether patients find the tool easy to interpret, (2) how accurately patients can predict their surgical risks, and (3) the impact of risk disclosure on levels of anxiety and future motivations to decrease personal risk.

METHODS

Patients (N = 150) recruited from a preoperative clinic completed an initial survey where they estimated their hospital length of stay and personal perioperative risks of the 12 clinical complications analyzed by the ACS Calculator. Next, risk calculation was performed by entering participants' demographics into the ACS Calculator. Participants reviewed their individualized risk reports in detail and then completed a follow-up survey to evaluate their perceptions.

RESULTS

Nearly 90% of participants desire to review their ACS Calculator report before future surgical consents. High-risk patients were 3 times more likely to underestimate their risk of any complication, serious complication, and length of stay compared to low-risk patients (P < .001). After reviewing their calculated risks, 70% stated that they would consider participating in prehabilitation to decrease perioperative risk, and nearly 40% would delay their surgery to do so. Knowledge of personal ACS risk calculations had no effect on anxiety in 20% and decreased anxiety in 71% of participants.

CONCLUSIONS

The ACS Calculator may be of particular benefit to high-risk surgical populations by providing realistic expectations of outcomes and recovery. Use of this tool may also provide motivation for patients to participate in risk reduction strategies.

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Olotu C, Lebherz L, Härter M, Mende A, Plümer L, Goetz AE, Zöllner C, Kriston L, Kiefmann R. Improvement of perioperative care of the elderly patient (PeriAge): protocol of a controlled interventional feasibility study. BMJ Open 2019;9:e031837. [PMID: 31767591 PMCID: PMC6886921 DOI: 10.1136/bmjopen-2019-031837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open

Abstract

INTRODUCTION

Geriatric patients have a pronounced risk to suffer from postoperative complications. While effective risk-specific perioperative measures have been studied in controlled experimental settings, they are rarely found in routine healthcare. This study aims (1) to implement a multicomponent preoperative and intraoperative intervention, and investigate its feasibility, and (2) exploratorily assess the effectiveness of the intervention in routine healthcare.

METHODS AND ANALYSIS

Feasibility and exploratory effectiveness of the intervention will be investigated in a monocentric, prospective, non-randomised, controlled trial. The intervention includes systematic information for patients and family about measures to prevent postoperative complications; preoperative screening for frailty, malnutrition, strength and mobility with nutrient supplementation and physical exercise (prehabilitation) as needed. Further components focus on potentially inadequate medication, patient blood-management and carbohydrate loading prior to surgery, retainment of orientation aids in the operating room and a geriatric anaesthesia concept. Data will successively be collected from control, implementation and intervention groups. Patients aged 65+ with impending surgery will be included. A sample size of 240, n=80 per group, is planned. Assessments will take place at inclusion and 2, 30 and 180 days after surgery. Mixed-methods analyses will be performed. Exploratory effectiveness will be assessed using mixed segmented regressions. The primary endpoint is functional status. Secondary endpoints include cognitive performance, health-related quality of life, length of inpatient stay and occurrence of postoperative complications. Feasibility will be assessed through semi-structured interviews with staff and patients and quantitative analyses of the data quality, focussing on practicability, acceptance, adoption and fidelity to protocol.

ETHICS AND DISSEMINATION

The study will be carried out in accordance with the Helsinki Declaration and to principles of good scientific practice. The Ethics Committee of the Medical Association Hamburg, Germany, approved the protocol (study ID: PV5596). Results will be disseminated in scientific journals and healthcare conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT03325413.

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Punnoose A, Weiss O, Khanduja V, Rushton AB. Effectiveness of prehabilitation for patients undergoing orthopaedic surgery: protocol for a systematic review and meta-analysis. BMJ Open 2019;9:e031119. [PMID: 31748299 PMCID: PMC6887053 DOI: 10.1136/bmjopen-2019-031119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 11/10/2022] Open

Abstract

INTRODUCTION

Undergoing major surgery can induce physical and functional decline. Prehabilitation programmes aim to improve physical fitness and function preoperatively and could enhance postoperative recovery and outcomes. Prehabilitation interventions have been utilised across a range of orthopaedic populations of all ages and can be multimodal in nature. The aim of this study is to evaluate the effectiveness of prehabilitation for patients undergoing orthopaedic surgery including day surgery procedures. It will also investigate the components of prehabilitation to understand optimum duration and frequency of programmes.

METHODS/DESIGN

Systematic review and meta-analysis designed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A comprehensive electronic search will be performed in MEDLINE, CINAHL, AMED, Embase, PEDro and Cochrane CENTRAL databases in order to identify randomised control trials published between January 2000 to 25 March 2019. ISI Web of Science, System for information on grey literature and the European Union clinical trials registry will identify studies that are underway or unpublished. Two independent reviewers will carry out the searches, study selection (title and abstract and full text stages), data extraction, risk of bias assessment (Cochrane Risk of Bias tool 2.0) and evaluation of overall strength of evidence. Meta-analyses will be used for data which demonstrates homogeneity, otherwise a narrative synthesis will be performed for groups of studies of high heterogeneity (I2 >50%). The overall strength of the body of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation.

ETHICS AND DISSEMINATION

This study raises no ethical issues. This study aims to identify the effectiveness of prehabilitation interventions and may assist clinicians in determining which components, duration, frequency and the method of delivery would form the most effective prehabilitation intervention for patients undergoing an orthopaedic surgical procedure. The findings will be disseminated through publication in a peer-reviewed journal and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42019123268.

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Benson R, McGregor G, Shehata M, Imray C. Optimising fitness for major vascular surgery. BMJ 2019;366:l5002. [PMID: 31477574 DOI: 10.1136/bmj.l5002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Borrell-Vega J, Esparza Gutierrez AG, Humeidan ML. Multimodal Prehabilitation Programs for Older Surgical Patients. Anesthesiol Clin 2019;37:437-452. [PMID: 31337477 DOI: 10.1016/j.anclin.2019.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

Doganay E, Moorthy K. Prehabilitation for esophagectomy. J Thorac Dis 2019;11:S632-S638. [PMID: 31080639 DOI: 10.21037/jtd.2019.02.12] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]

Frailty indexes in perioperative and critical care: A systematic review. Arch Gerontol Geriatr 2018;79:88-96. [DOI: 10.1016/j.archger.2018.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022]

Karamnov S, Brovman EY, Greco KJ, Urman RD. Risk Factors and Outcomes Associated With Sepsis After Coronary Artery Bypass and Open Heart Valve Surgeries. Semin Cardiothorac Vasc Anesth 2018;22:359-368. [PMID: 29992859 DOI: 10.1177/1089253218785362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]

Abstract

PURPOSE

Sepsis causes significant morbidity and mortality after cardiac surgery and carries a significant burden on health care costs. There is a general association of increased risk of post-cardiac surgery sepsis in patients with postoperative complications. We sought to investigate significant patient and procedural risk factors and outcomes associated with sepsis after cardiac surgery.

MATERIALS AND METHODS

In this retrospective study, we analyzed 531 coronary artery bypass grafting and open heart valve surgery cases that developed postoperative sepsis in the National Surgical Quality Improvement Program database between 2007 and 2014. Patient-based and surgery-based parameters were analyzed for risk factors and outcomes reported in the 30 days postoperatively. The association between sepsis and patient outcomes was assessed in a propensity-matched cohort using univariable logistic regression.

RESULTS

Modifiable and nonmodifiable patient characteristics, including age >80, poor preoperative functional status, chronic diseases such as diabetes mellitus, congestive heart failure, chronic kidney disease with serum creatinine ⩾1.5, as well as serum albumin <3.5 and emergent nature of the case were associated with post-cardiac surgery sepsis. Surgical outcomes associated with sepsis included mortality (15.4% vs 4.5%), unplanned intubation (29.8% vs 8.2%), transfusion (53.4% vs 48.4%), acute kidney injury (7.1% vs 1.4%), postoperative dialysis (18.8% vs 3.5%), and return to the operating room (29.8% vs 8.2%).

CONCLUSIONS

We identified multiple patient and surgical characteristics as well as postoperative outcomes associated with postoperative sepsis development in the high-risk population of patients undergoing cardiac surgery. Early identification of patients who are at high risk for postoperative sepsis can facilitate early treatment interventions.

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Stethen TW, Ghazi YA, Heidel RE, Daley BJ, Barnes L, McLoughlin JM. Factors Influencing Length of Stay after Elective Bowel Resection within an Enhanced Recovery Protocol. Am Surg 2018. [DOI: 10.1177/000313481808400746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]

Polastri M. Fast-track post-operative rehabilitation to maximise outcomes of minimally invasive surgical procedures. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.5.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]

Berkel AEM, Bongers BC, van Kamp MJS, Kotte H, Weltevreden P, de Jongh FHC, Eijsvogel MMM, Wymenga ANM, Bigirwamungu-Bargeman M, van der Palen J, van Det MJ, van Meeteren NLU, Klaase JM. The effects of prehabilitation versus usual care to reduce postoperative complications in high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: study protocol of a randomized controlled trial. BMC Gastroenterol 2018;18:29. [PMID: 29466955 PMCID: PMC5822670 DOI: 10.1186/s12876-018-0754-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022] Open

Affiliation(s)

Annefleur E M Berkel Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands.
Bart C Bongers Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
Marie-Janne S van Kamp Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
Hayke Kotte Physical therapy practice, Fysio Twente, J.J. van Deinselaan 34a, 7541, PE, Enschede, The Netherlands
Paul Weltevreden Physical therapy practice, FITclinic, Roomweg 180, 7523, BT, Enschede, The Netherlands
Frans H C de Jongh Department of Pulmonology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
Michiel M M Eijsvogel Department of Pulmonology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
A N Machteld Wymenga Department of Internal medicine, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
Marloes Bigirwamungu-Bargeman Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
Job van der Palen Epidemiology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
Marc J van Det Department of Surgery, Ziekenhuisgroep Twente, PO Box 7600, 7600, SZ, Almelo, The Netherlands
Nico L U van Meeteren Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.,Top Sector Life Sciences and Health (Health~Holland), Laan van Nieuw Oost-Indië 334, 2593, CE, The Hague, The Netherlands
Joost M Klaase Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands

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Cabilan CJ, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. ACTA ACUST UNITED AC 2018;13:146-87. [PMID: 26447015 DOI: 10.11124/jbisrir-2015-1885] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]

Abstract

BACKGROUND

Major surgery can induce functional decline and pain, which can also have negative implications on health care utilization and quality of life. Prehabilitation is the process of optimizing physical functionality preoperatively to enable the individual to maintain a normal level of function during and after surgery. Prehabilitation training can be a combination of aerobic exercises, strength training, and functional task training to suit individual needs.

OBJECTIVES

To evaluate the impact of prehabilitation on physical functional status, health care utilization, quality of life, and pain after surgery.

INCLUSION CRITERIA

Studies of adult surgical patients, excluding day surgery patients.Any preoperative exercise interventions identified in the study as part of a prehabilitation or preoperative exercise program, versus usual care.Randomized controlled trials.Functional status, health care utilization, quality of life and pain.

SEARCH STRATEGY

Published (CINAHL, CENTRAL, EMBASE, MEDLINE, PEDro) and unpublished studies between 1996 and March 2013 were searched extensively.

METHODOLOGICAL QUALITY

All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality.

DATA COLLECTION

Data from included papers were extracted using a modified data extraction tool.

DATA SYNTHESIS

Where possible, study results were pooled in statistical meta-analysis. Alternatively, results are presented in narrative and table form.

RESULTS

A total of 3167 citations were identified; after removal of duplicates, assessment for relevance and eligibility, 33 studies underwent critical appraisal. Seventeen studies met the quality criteria and were included in quantitative synthesis. Thirteen studies were conducted in orthopedics (mainly knee or hip arthroplasty for osteoarthritis), one in colorectal, two in cardiac and one in upper gastrointestinal/hepatobiliary. Function, pain and quality of life were quantified according to prehabilitation dose and postoperative months. Prehabilitation, at any dose, did not demonstrate benefits in objective and self-reported function at any of the postoperative time points. Prehabilitation did not demonstrate benefits in quality of life or pain; however, there was significant evidence that prehabilitation doses of more than 500 minutes reduced the need for postoperative rehabilitation, but no significant reduction was found in readmissions or nursing home placement.

CONCLUSIONS

Results from this review reveal that prehabilitation has no significant postoperative benefits in function, quality of life and pain in patients who have had knee or hip arthroplasty for osteoarthritis; however, there is evidence that prehabilitation may reduce admission to rehabilitation in this population. The evidence on postoperative benefits of prehabilitation in other surgical populations is limited; however, preliminary evidence does not demonstrate better outcomes.

IMPLICATIONS FOR PRACTICE

There is no evidence that prehabilitation provides benefits in function, pain or quality of life in patients who have had arthroplasty for osteoarthritis; however prehabilitation doses of more than 500 minutes might reduce acute rehabilitation admissions. The evidence is insufficient to provide recommendations on the benefits of prehabilitation in other surgical populations.

IMPLICATIONS FOR RESEARCH

Future prehabilitation studies are not recommended in patients with osteoarthritis for whom arthroplasty is planned. However, should prehabilitation be tested in other surgical populations, programs must consider patient suitability, setting, delivery of intervention and clinical effectiveness. It is also recommended that the exercises prescribed should be maintained and adhered to after surgery. Most importantly, prehabilitation studies must have adequately powered sample sizes.

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Multimodal Prehabilitation Programs as a Bundle of Care in Gastrointestinal Cancer Surgery: A Systematic Review. Dis Colon Rectum 2018;61:124-138. [PMID: 29219922 DOI: 10.1097/dcr.0000000000000987] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Abstract

BACKGROUND

Prehabilitation reflects a proactive process of preoperative optimization undertaken between cancer diagnosis and definitive surgical treatment, with the intent of improving physiological capacity to withstand the major insult of surgery. Prehabilitation before GI cancer surgery is currently not widely adopted, and most research has focused on unimodal interventions such as exercise therapy, nutritional supplementation, and hematinic optimization. A review of the existing literature was undertaken to investigate the impact of multimodal prehabilitation programs as a "bundle of care."

DATA SOURCE

A systematic literature search was performed utilizing Medline, PubMed, Embase, Cinahl, Cochrane, and Google Scholar databases.

STUDY SELECTION

The quality of studies was assessed by using the Cochrane tool for assessing risk of bias (randomized trials) and the Newcastle-Ottawa Quality Assessment scale (cohort studies).

INTERVENTION

Studies were chosen that involved pre-operative optimization of patients before GI cancer surgery.

MAIN OUTCOMES

The primary outcome measured was the impact of prehabilitation programs on preoperative fitness and postoperative outcomes.

RESULTS

Of the 544 studies identified, 20 were included in the qualitative analysis. Two trials investigated the impact of multimodal prehabilitation (exercise, nutritional supplementation, anxiety management). Trials exploring prehabilitation with unimodal interventions included impact of exercise therapy (7 trials), impact of preoperative iron replacement (5 trials), nutritional optimization (5 trials), and impact of preoperative smoking cessation (2 trials). Compliance within the identified studies was variable (range: 16%-100%).

LIMITATIONS

There is a lack of adequately powered trials that utilize objective risk stratification and uniform end points. As such, a meta-analysis was not performed because of the heterogeneity in study design.

CONCLUSION

Although small studies are supportive of multimodal interventions, there are insufficient data to make a conclusion about the integration of prehabilitation in GI cancer surgery as a bundle of care. Larger, prospective trials, utilizing uniform objective risk stratification and structured interventions, with predefined clinical and health economic end points, are required before definitive value can be assigned to prehabilitation programs.

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Morey MC, Manning KM, Guo Y, McDonald SR, Heflin MT, Porter Starr KN, Sloane R, Loyack NL, Lagoo-Deenadayalan S. Physical Activity Trackers: Promising Tools to Promote Resilience in Older Surgical Patients. ACTA ACUST UNITED AC 2018;9. [PMID: 31106298 DOI: 10.29011/2575-9760.001156] [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: 11/19/2022]

Affiliation(s)

Miriam C Morey Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
Kenneth M Manning Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina
Ying Guo Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina.,Duke- National University of Singapore Medical School, Singapore
Shelley R McDonald Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
Mitchell T Heflin Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
Kathryn N Porter Starr Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
Richard Sloane Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
Nancy L Loyack Surgery, Durham VA Healthcare System, Durham, North Carolina
Sandhya Lagoo-Deenadayalan Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina.,Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Surgery, Durham VA Healthcare System, Durham, North Carolina

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Brinson EL, Thornton KC. Preoperative Risk Assessment of Respiratory Failure. Int Anesthesiol Clin 2017;56:26-46. [PMID: 29227310 DOI: 10.1097/aia.0000000000000170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]

Vigorous intensity aerobic interval exercise in bladder cancer patients prior to radical cystectomy: a feasibility randomised controlled trial. Support Care Cancer 2017;26:1515-1523. [PMID: 29181804 DOI: 10.1007/s00520-017-3991-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/20/2017] [Indexed: 01/06/2023]

Prehabilitation in gynecological surgery? What do gynecologists know and need to know. Arch Gynecol Obstet 2017;297:27-31. [DOI: 10.1007/s00404-017-4565-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/11/2017] [Indexed: 11/25/2022]

Driessen EJ, Peeters ME, Bongers BC, Maas HA, Bootsma GP, van Meeteren NL, Janssen-Heijnen ML. Effects of prehabilitation and rehabilitation including a home-based component on physical fitness, adherence, treatment tolerance, and recovery in patients with non-small cell lung cancer: A systematic review. Crit Rev Oncol Hematol 2017;114:63-76. [DOI: 10.1016/j.critrevonc.2017.03.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/22/2017] [Indexed: 01/24/2023] Open

Shaughness G, Howard R, Englesbe M. Patient-centered surgical prehabilitation. Am J Surg 2017;216:636-638. [PMID: 28456341 DOI: 10.1016/j.amjsurg.2017.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 01/12/2023]

European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017;34:192-214. [DOI: 10.1097/eja.0000000000000594] [Citation(s) in RCA: 491] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Systematic review: the impact of exercise on mesenteric blood flow and its implication for preoperative rehabilitation. Tech Coloproctol 2017;21:185-201. [PMID: 28243813 PMCID: PMC5360832 DOI: 10.1007/s10151-017-1589-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/11/2017] [Indexed: 11/03/2022]

Weston M, Batterham AM, Tew GA, Kothmann E, Kerr K, Nawaz S, Yates D, Danjoux G. Patients Awaiting Surgical Repair for Large Abdominal Aortic Aneurysms Can Exercise at Moderate to Hard Intensities with a Low Risk of Adverse Events. Front Physiol 2017;7:684. [PMID: 28119627 PMCID: PMC5220106 DOI: 10.3389/fphys.2016.00684] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022] Open

Abstract

Purpose: Intervention fidelity refers to the extent an experimental manipulation has been implemented as intended. Our aim was to evaluate the fidelity of high-intensity interval training (HIT) in patients awaiting repair of large abdominal aortic aneurysms.

Methods: Following a baseline cardiopulmonary exercise test, 27 participants performed a hospital-based, supervised HIT intervention in the 4 weeks preceding surgery. The intervention was performed thrice weekly on a cycle ergometer and involved either 8 × 2-min intervals, each interspersed by 2-min recovery periods, or 4 × 4-min intervals interspersed with 4-min recovery periods. When surgery was delayed, participants undertook one maintenance HIT session per week until surgery. Session one power output was set to baseline anaerobic threshold power output and then increased on subsequent sessions until ratings of perceived exertion (RPE; Borg CR-10) for the legs (RPE-L) and sense of breathlessness/ chest (RPE-C) were hard (5) to very hard (7) at the end of each interval. For safety, power output was maintained or reduced if systolic blood pressure exceeded 180 mm Hg or heart rate exceeded 95% of maximum.

Results: Overall session attendance across the 4-week HIT intervention was 74%. Seventeen participants met our compliance criteria of ≥75% of intervention sessions and all maintenance sessions. When compared to non-compliance, compliant participants had higher fitness, performed more HIT sessions and were able to exercise at higher exercise intensities with a lower proportion of exercise safety breaches. In the 17 compliant participants, the proportion of repetitions meeting the HIT criterion was 30% (RPE-L) and 16% (RPE-C). Mean repetition intensity was 4.1 ± 2.0 Arbitrary Units [AU] (RPE-L) and 3.5 ± 1.9 AU (RPE-C) with a within-subject variability of ±1.4 AU and ±1.6 AU, respectively. We observed higher RPE scores (~0.5 AU) following 2-min intervals when compared to 4-min intervals and exercise power output increased 23% across the 4-week HIT intervention. One participant experienced an adverse event but were still able to complete their remaining exercise sessions.

Conclusions: Despite an inconsistent and lower than prescribed intensity, it is possible to exercise this high-risk patient population at moderate to hard intensities with a low risk of adverse events.

Clinical Trial Registration:http://www.isrctn.com/, registration number ISRCTN09433624.

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Cuadros L, Ismail H, Ho K. Evaluation of Reliability of MYZONE MZ-3 Heart Rate Monitor: A Study for the Future of Telephysiotherapy for Preoperative Prehabilitation in Cancer Patients. Telemed J E Health 2016;23:334-338. [PMID: 27537777 DOI: 10.1089/tmj.2016.0138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open

Angenete E, Angerås U, Börjesson M, Ekelund J, Gellerstedt M, Thorsteinsdottir T, Steineck G, Haglind E. Physical activity before radical prostatectomy reduces sick leave after surgery - results from a prospective, non-randomized controlled clinical trial (LAPPRO). BMC Urol 2016;16:50. [PMID: 27531014 PMCID: PMC4986175 DOI: 10.1186/s12894-016-0168-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/08/2016] [Indexed: 02/24/2023] Open

Abstract

BACKGROUND

Studies have reported that early physical rehabilitation after surgical procedures is associated with improved outcome measured as shorter hospital stay and enhanced recovery. The aim of this study was to explore the relationship between the preoperative physical activity level and subsequent postoperative complications, sick-leave and hospital stay after radical prostatectomy for prostate cancer in the setting of the LAPPRO trial (LAParoscopic Prostatectomy Robot Open).

METHODS

LAPPRO is a prospective controlled trial, comparing robot-assisted laparoscopic and open surgery for localized prostate cancer between 2008 and 2011. 1569 patients aged 64 or less with an occupation were included in this sub-study. The Gleason score was <7 in 52 % of the patients. Demographics and the level of self-assessed preoperative physical activity, length of hospital stay, complications, quality of life, recovery and sick-leave were extracted from clinical record forms and questionnaires. Multivariable logistic regression, with log-link and logit-link functions, was used to adjust for potential confounding variables.

RESULTS

The patients were divided into four groups based on their level of activity. As the group with lowest engagement of physical activity was found to be significantly different in base line characteristics from the other groups they were excluded from further analysis. Among patients that were physically active preoperativelly (n = 1467) there was no significant difference between the physical activity-groups regarding hospital stay, recovery or complications. However, in the group with the highest self-assessed level of physical activity, 5-7 times per week, 13 % required no sick leave, compared to 6.3 % in the group with a physical activity level of 1-2 times per week only (p < 0.0001).

CONCLUSIONS

In our study of med operated with radical prostatectomy, a high level of physical activity preoperatively was associated with reduced need for sick leave after radical prostatectomy compared to men with lower physical activity.

TRIAL REGISTRATION

The trial is registered at the ISCRTN register. ISRCTN06393679 .

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Armstrong KW, Bravo-Iñiguez CE, Jacobson FL, Jaklitsch MT. Recent trends in surgical research of cancer treatment in the elderly, with a primary focus on lung cancer: Presentation at the 2015 annual meeting of SIOG. J Geriatr Oncol 2016;7:368-74. [PMID: 27460994 DOI: 10.1016/j.jgo.2016.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/16/2016] [Accepted: 07/07/2016] [Indexed: 11/27/2022]

Reeves N, Hughes D, Pathak S. Response to Samuelsson et al.: Inappropriate drug use in elderly patients is associated with prolonged hospital stay and increased postoperative mortality after colorectal cancer surgery: a population-based study. Colorectal Dis 2016;18:725-6. [PMID: 27149096 DOI: 10.1111/codi.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 02/08/2023]

Huffman DM, Schafer MJ, LeBrasseur NK. Energetic interventions for healthspan and resiliency with aging. Exp Gerontol 2016;86:73-83. [PMID: 27260561 DOI: 10.1016/j.exger.2016.05.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 12/16/2022]

Perry R, Scott LJ, Richards A, Haase AM, Savović J, Ness AR, Atkinson C, Harris J, Culliford L, Shah S, Pufulete M. Pre-admission interventions to improve outcome after elective surgery-protocol for a systematic review. Syst Rev 2016;5:88. [PMID: 27216584 PMCID: PMC4878054 DOI: 10.1186/s13643-016-0266-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open

Huang GH, Ismail H, Murnane A, Kim P, Riedel B. Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study. Support Care Cancer 2016;24:2277-2285. [PMID: 26590843 DOI: 10.1007/s00520-015-3028-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 11/15/2015] [Indexed: 02/03/2023]

Plumb JOM, Otto JM, Grocott MPW. 'Blood doping' from Armstrong to prehabilitation: manipulation of blood to improve performance in athletes and physiological reserve in patients. EXTREME PHYSIOLOGY & MEDICINE 2016;5:5. [PMID: 26929820 PMCID: PMC4770708 DOI: 10.1186/s13728-016-0046-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 02/12/2016] [Indexed: 02/07/2023]

Abstract

Haemoglobin is the blood’s oxygen carrying pigment and is encapsulated in red blood corpuscles. The concentration of haemoglobin in blood is dependent on both its total mass in the circulation (tHb-mass) and the total plasma volume in which it is suspended. Aerobic capacity is defined as the maximum amount of oxygen that can be consumed by the body per unit time and is one measure of physical fitness. Observations in athletes who have undergone blood doping or manipulation have revealed a closer relationship between physical fitness (aerobic capacity) and total haemoglobin mass (tHb-mass) than with haemoglobin concentration ([Hb]). Anaemia is defined by the World Health Organisation (WHO) as a haemoglobin concentration of <130 g/L for men and <120 g/L for women. Perioperative anaemia is a common problem and is associated with increased mortality and morbidity following surgery. Aerobic capacity is also associated with outcome following major surgery, with less fit patients having a higher incidence of mortality and morbidity after surgery. Taken together, these observations suggest that targeted preoperative elevation of tHb-mass may raise aerobic capacity both directly and indirectly (by augmenting preoperative exercise initiatives- ‘prehabilitation’) and thus improve postoperative outcome. This notion in turn raises a number of questions. Which measure ([Hb] or tHb-mass) has the most value for the description of oxygen carrying capacity? Which measure has the most utility for targeting therapies to manipulate haemoglobin levels? Do the newer agents being used for blood manipulation (to increase tHb-mass) in elite sport have utility in the clinical environment? This review explores the literature relating to blood manipulation in elite sport as well as the relationship between perioperative anaemia, physical fitness and outcome following surgery, and suggests some avenues for exploring this area further.

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Kristensen SA, Jensen BT. Testing inter-rater reliability of the Urostomy Education Scale. Eur J Oncol Nurs 2016;20:17-23. [DOI: 10.1016/j.ejon.2015.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023]

Weston M, Weston KL, Prentis JM, Snowden CP. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions. Perioper Med (Lond) 2016;5:2. [PMID: 26770671 PMCID: PMC4712564 DOI: 10.1186/s13741-015-0026-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 12/15/2015] [Indexed: 12/12/2022] Open

Abstract

The advancement of perioperative medicine is leading to greater diversity in development of pre-surgical interventions, implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these interventions, the prescription of pre-operative exercise training is gathering momentum as a realistic means for enhancing patient surgical outcome. Indeed, the general benefits of exercise training have the potential to pre-operatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function.

Any exercise programme incorporated into the pre-operative pathway of care needs to be effective and time efficient in that any fitness gains are achievable in the limited period between the decision for surgery and operation (e.g. 4 weeks). Fortunately, there is a large volume of research describing effective and time-efficient exercise training programmes within the discipline of sports science. Accordingly, the objective of our commentary is to synthesise contemporary exercise training research, both from non-clinical and clinical populations, with the overarching aim of informing the development of effective and time-efficient pre-surgical exercise training programmes.

The development of such exercise training programmes requires the careful consideration of several key principles, namely frequency, intensity, time, type and progression of exercise. Therefore, in light of more recent evidence demonstrating the effectiveness and time efficiency of high-intensity interval training—which involves brief bouts of intense exercise interspersed with longer recovery periods—the principles of exercise training programme design will be discussed mainly in the context of such high-intensity interval training programmes. Other issues pertinent to the development, implementation and evaluation of pre-operative exercise training programmes, such as individual exercise prescription, training session monitoring and potential barriers and risks to high-intensity exercise are also discussed. The evidence presented suggests that individually prescribed and supervised high-intensity interval training programmes, encompassing a variety of exercise modes represent an effective and safe means of exercise therapy prior to surgery.

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Chia CLK, Mantoo SK, Tan KY. 'Start to finish trans-institutional transdisciplinary care': a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis 2016;18:O43-O50. [PMID: 26500155 DOI: 10.1111/codi.13166] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 09/22/2015] [Indexed: 02/08/2023]

Preoperative Cognitive and Frailty Screening in the Geriatric Surgical Patient: A Narrative Review. Clin Ther 2015;37:2666-75. [PMID: 26626609 DOI: 10.1016/j.clinthera.2015.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/17/2022]

Impact of Preoperative Environmental Enrichment on Prevention of Development of Cognitive Impairment following Abdominal Surgery in a Rat Model. Anesthesiology 2015;123:160-70. [PMID: 26001032 DOI: 10.1097/aln.0000000000000697] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

Abstract

BACKGROUND

Sustained neuroinflammation may contribute to the pathogenesis of postoperative cognitive dysfunction (POCD). Here, the authors evaluated the preventive effect of preoperative environmental enrichment (PEE) on the development of neuroinflammation and concomitant POCD in a rat abdominal surgery model.

METHODS

Young and aged rats were assigned to one of four groups using a 2 × 2 experimental design: PEE versus sedentary condition for 14 days, by abdominal surgery versus anesthesia alone (n = 8 in each group). After a 7-day postsurgical recovery period, cognitive function was assessed using a novel object recognition test, followed by measurement of hippocampal levels of proinflammatory cytokines. Under identical conditions, microglia were isolated from the hippocampus for assessment of cytokine response to lipopolysaccharide.

RESULTS

In the sedentary group, aged, but not young, rats receiving surgery showed memory deficits (novel object preference during testing phase of 54.6 ± 7.8% vs. 76.9 ± 11.3% in nonsurgery group, P < 0.05) and increased hippocampal levels of cytokines compared with nonsurgical rats. PEE had no effects on novel object preference in nonsurgery animals (78.6 ± 10.7%), whereas it attenuated surgery-induced impairment of novel object preference (70.9 ± 15.0%, P < 0.05 vs. sedentary/surgery group) as well as increase of cytokine levels in hippocampus. Furthermore, upon ex vivo stimulation with lipopolysaccharide, cytokines release from hippocampal microglia isolated from aged rats before intervention was significantly higher in comparison with young rats. PEE resulted in reduction of these age-related microglial phenotypic changes.

CONCLUSIONS

PEE could prevent the development of neuroinflammation and related POCD in aged rats by reversion of a proinflammatory phenotype of hippocampal microglia.

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