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Blaurock M, Busch CJ, Wiese ML. [Prehabilitation and enhanced recovery after surgery protocols for head and neck cancer : Value and application of these concepts]. HNO 2025; 73:430-440. [PMID: 40338349 DOI: 10.1007/s00106-025-01637-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2025] [Indexed: 05/09/2025]
Abstract
Prehabilitation is gaining traction in complex oncological interventions and treatments. This CME article is focused on the basic principles of prehabilitation. We discuss the objective evaluation of physical fitness and how to improve it by physio- and speech therapy. Thereafter, we explain how to judge nutritional status, especially in oncological patients, and discuss modes of nutritional supplementation. Finally, the enhanced recovery after surgery concept is briefly explained and its current value in head and neck cancer patients discussed.
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Affiliation(s)
- Markus Blaurock
- Klinik für Hals‑, Nasen‑, Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland.
| | - Chia-Jung Busch
- Klinik für Hals‑, Nasen‑, Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland
| | - Mats Lukas Wiese
- Fachbereich Oecotrophologie, Facility Management, FH Münster, Münster, Deutschland
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2
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Henry O, Mack P, Wunsch H. Review of the anaesthetic management of patients with post-polio syndrome. Br J Anaesth 2025; 134:1385-1391. [PMID: 40118672 DOI: 10.1016/j.bja.2025.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 01/20/2025] [Accepted: 02/16/2025] [Indexed: 03/23/2025] Open
Abstract
Post-polio syndrome (PPS) is a condition affecting individuals who have previously contracted and recovered from poliomyelitis. It is estimated that up to 20 million people worldwide are still living with the sequelae of polio, and 20-85% of these people may develop PPS. PPS, a diagnosis of exclusion, includes symptoms of new-onset muscle weakness, fatigue, pain, and muscular atrophy that occurs at least 15 yr after an acute polio infection. These patients may present for surgery with or without a formal diagnosis of PPS, requiring anaesthesia clinicians to understand the specific considerations for patients with, or at risk of, PPS. This review addresses specific anaesthetic concerns in PPS care, assessing current research to guide management and highlighting significant evidence gaps. The topics reviewed include the pathophysiology and characteristics of PPS with potential anaesthetic implications, and relevant outcomes data for patients with PPS undergoing anaesthesia. Key areas of concern in the PPS literature included respiratory function, dysphagia, cold intolerance, and sensitivity to anaesthetic agents. Existing studies on patients with PPS receiving anaesthesia were primarily case reports, with a lack of large-scale, controlled studies. Areas of continued controversy include ambiguity regarding tolerance to opioids, the use of neuraxial anaesthesia, and sensitivity to anaesthetic agents and neuromuscular blocking agents. Preoperative evaluation should include careful assessment of respiratory and swallowing function, with advanced planning for intraoperative and postoperative management using a multidisciplinary approach. Further research is needed to understand anaesthetic risks and develop evidence-based guidelines for this unique patient population.
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Affiliation(s)
- Olivia Henry
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
| | - Patricia Mack
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Hannah Wunsch
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
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Zhang W, Lu X, Yang N, Zhu X, Hu H. Prehabilitation is effective in relieving pain after knee arthroplasty, but has little effect on length of stay and knee function: a meta-analysis of randomized controlled trials. Front Med (Lausanne) 2025; 12:1457407. [PMID: 40357305 PMCID: PMC12066442 DOI: 10.3389/fmed.2025.1457407] [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: 06/30/2024] [Accepted: 03/24/2025] [Indexed: 05/15/2025] Open
Abstract
Purpose The efficacy of preoperative rehabilitation (prehabilitation) for patients undergoing knee arthroplasty remains controversial. Prehabilitation is defined as the implementation of functional exercises, health education, and preemptive medication before surgery to improve postoperative outcomes, typically compared to conventional care protocols. Existing studies have reported inconsistent results regarding its benefits. This meta-analysis aims to evaluate the impact of prehabilitation on hospital length of stay, postoperative pain, and knee function in patients undergoing knee arthroplasty. Methods PubMed, Cochrane, Embase, and Web of Science were searched from their establishment to 16 January 2024. An additional 19 articles were obtained by reading the relevant literature or by a reference search. All clinical randomized controlled trials (RCTs) related to the prehabilitation of total knee arthroplasty were included. All trials were analyzed by two independent reviewers, and the resulting data were analyzed using a random effects model and processed using Review Manager5.4 statistical software. The main outcome measures are as follows: visual analog scale(VAS), knee flexion and extension, and length of stay (LOS). Results A total of 18 articles, encompassing 21 RCTs with 2,150 participants (1,167 in the prehabilitation group and 983 in the control group), were included. The analysis revealed that prehabilitation significantly reduced postoperative pain at 1, 3, and 6 months, as evidenced by lower VAS scores. Improvements in knee function were noted in terms of knee extension at 1 month and knee flexion at 3 months postoperatively. However, no significant difference was observed in the length of hospital stay. Conclusion Prehabilitation before knee arthroplasty effectively alleviates postoperative pain and partially enhances knee function in the early postoperative period but does not significantly affect the length of hospital stay.
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Affiliation(s)
- Weishuai Zhang
- The Fifth Ward of Orthopedics Department, Kaifeng People’s Hospital, Henan, China
| | - Xuchao Lu
- The Fifth Ward of Orthopedics Department, Kaifeng People’s Hospital, Henan, China
| | - Nannan Yang
- Department of Pain, Kaifeng People’s Hospital, Henan, China
| | - Xianyou Zhu
- The Fifth Ward of Orthopedics Department, Kaifeng People’s Hospital, Henan, China
| | - Haotian Hu
- The Fifth Ward of Orthopedics Department, Kaifeng People’s Hospital, Henan, China
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Eubanks JE, Gliedt JA, Cupler ZA, Bejarano G, Janssen ERC, Skolasky RL, Smeets RJEM, Schneider MJ. Preoperative spinal education for lumbar spinal stenosis (POSE-LSS): A qualitative analysis of patient experiences. PM R 2025. [PMID: 40257228 DOI: 10.1002/pmrj.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 10/22/2024] [Accepted: 02/17/2025] [Indexed: 04/22/2025]
Abstract
BACKGROUND Surgical intervention for lumbar spinal stenosis (LSS) is common and associated with high rates of postoperative side effects or complications. Prehabilitation programs aim to reduce postoperative complications and enhance outcomes. However, the clinical effectiveness of prehabilitation programs for patients undergoing LSS surgery has yet to be fully investigated. A key part of this investigation is to gain insight into how to design these programs through an iterative process that includes feedback from patients' experiences. OBJECTIVE To explore patients' experiences with a novel prehabilitation program: Pre-Operative Spinal Education for Lumbar Spinal Stenosis (POSE-LSS). DESIGN Individual structured telephone interviews with pragmatic qualitative analysis. SETTING Academic medical center. PARTICIPANTS Patients (n = 10) who underwent lumbar spinal stenosis surgery and completed the POSE-LSS program prior to their surgery were included (six women; four men, mean age: 62.3 years). INTERVENTIONS POSE-LSS is a novel multimodal, education-focused, time-efficient prehabilitation program for patients undergoing LSS surgery. Participants received the following: (1) educational booklet and video, (2) in-person physical therapy (PT) session, and (3) telemedicine visit with a physiatrist. OUTCOME MEASURES One-on-one structured interviews to understand patients' experiences with a LSS prehabilitation program. RESULTS Participants in this qualitative study described a favorable, unique, and feasible experience associated with participation in the POSE-LSS program. Three main themes were developed from these interviews about POSE-LSS: (1) it helped patients to better prepare for their surgery and improved postoperative expectations, (2) it addressed modifiable psychological factors associated with the surgical intervention, and (3) it fits into a larger support system necessary to meet patients' needs. CONCLUSIONS The perspectives gained from this qualitative study can inform improved design and evaluation of LSS prehabilitation programs.
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Affiliation(s)
- James E Eubanks
- Department of Orthopaedics and Physical Medicine and Rehabilitation, Division of Physical Medicine and Rehabilitation, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zachary A Cupler
- Physical Medicine and Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Geronimo Bejarano
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Esther R C Janssen
- Department of Orthopedic Surgery, VieCuri Medical Center, Venlo, The Netherlands
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard L Skolasky
- Orthopedic Surgery and Physical Medicine and Rehabilitation, Surgical Outcomes Research Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University and CIR Revalidatie, Eindhoven, The Netherlands
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Dahan-Oliel N, Cachecho S, Araujo C, Fąfara A, Lacombe F, Samargian A, Costa C, Donohoe M, Flanagan A, Kowalczyk B, Krakie C, Wagner L, Navalón C, Pacey V, Steen U, Walker M, Wong T, Bussières A. Consensus-based recommendations for the rehabilitation of children with arthrogryposis multiplex congenita: an integrated knowledge translation approach. Orphanet J Rare Dis 2025; 20:168. [PMID: 40205440 PMCID: PMC11983950 DOI: 10.1186/s13023-025-03671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 03/17/2025] [Indexed: 04/11/2025] Open
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is a group of rare disorders characterized by multiple joint contractures present at birth. Early rehabilitation is essential to minimize joint contractures and maximize autonomy and participation among individuals with AMC. However, there is little robust scientific evidence to inform best practice. This project aimed to develop consensus-based recommendations for the rehabilitation management of children with AMC in the following priority areas: early intervention and motor development, muscle and joint function, orthotics, mobility, participation in areas of life, pain, psychosocial wellbeing, and perioperative rehabilitation. RESULTS This multi-phase project used an integrated knowledge translation approach. Based on the results from scoping reviews on the priority areas identified for the rehabilitation of children with AMC, and a clinician survey describing current practices in AMC rehabilitation, three panels of expert clinicians in occupational therapy, physical therapy, orthopedics, physiatry, and social work, as well as people with lived experience and researchers from 10 countries developed consensus-based recommendations for rehabilitation, in concordance with the Grading of Recommendations, Assessment, Development and Evaluations framework (GRADE) criteria. A modified Delphi process was completed with a wider group of international AMC experts to revise and validate the recommendations (Round 1 = 41 and Round 2 = 37 experts). A five-member external review panel appraised the recommendations using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. The final 16 recommendations reached a mean agreement rate of 96.6% after two Delphi rounds. The overall quality was rated at 96.6% on the AGREE II tool. Interviews with clinicians and managers identified facilitators and barriers to implementation of the recommendations in practice using the Theoretical Domain Framework. CONCLUSION Consensus-based, expert validated recommendations for the rehabilitation of children with AMC were developed by a wide range of stakeholders, healthcare users and providers. The proposed recommendations are expected to contribute to improving child- and family-centered practice and health outcomes. Future work includes a knowledge translation strategy to promote sharing and implementation of the recommendations in practice.
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Affiliation(s)
- Noémi Dahan-Oliel
- Shriners Hospital for Children-Canada, 1003, Boulevard Décarie, Montréal, QC, H4A 0A9, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Sarah Cachecho
- Shriners Hospital for Children-Canada, 1003, Boulevard Décarie, Montréal, QC, H4A 0A9, Canada.
| | - Clarice Araujo
- Shriners Hospital for Children-Canada, 1003, Boulevard Décarie, Montréal, QC, H4A 0A9, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Alicja Fąfara
- Institute of Physiotherapy, Jagiellonian University Medical College, Kraków, Poland
| | | | | | - Camille Costa
- Shriners Hospital for Children-Canada, 1003, Boulevard Décarie, Montréal, QC, H4A 0A9, Canada
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
| | - Maureen Donohoe
- Nemours/Alfred I duPont Hospital for Children, Delaware, USA
| | | | - Bart Kowalczyk
- Department of Orthopedics, University Children's Hospital, Kraków, Poland
| | | | - Lisa Wagner
- Shriners Children's-Greenville, Greenville, USA
| | - Carolina Navalón
- Asociación Artrogriposis Múltiple Congénita España, Madrid, Spain
| | - Verity Pacey
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Unni Steen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Alværn, Norway
| | | | - Trudy Wong
- Shriners Hospital for Children-Canada, 1003, Boulevard Décarie, Montréal, QC, H4A 0A9, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
- Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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D'Amico F, Dormio S, Veronesi G, Guarracino F, Donadello K, Cinnella G, Rosati R, Pecorelli N, Baldini G, Pieri M, Landoni G, Turi S. Home-based prehabilitation: a systematic review and meta-analysis of randomised trials. Br J Anaesth 2025; 134:1018-1028. [PMID: 39919985 PMCID: PMC11947603 DOI: 10.1016/j.bja.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/30/2024] [Accepted: 01/01/2025] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Prehabilitation aims to enhance preoperative functional capacity through exercise, nutrition, and psychological programs. Home-based prehabilitation represents an alternative to hospital prehabilitation, with the advantage of not utilising hospital resources. This review aims to evaluate adherence and clinical effectiveness of home-based prehabilitation. METHODS We searched PubMed, Cochrane, and Embase up to October 1, 2024 for randomised controlled trials comparing home-based prehabilitation with standard care. The primary outcome was the proportion of patients with postoperative complications. Secondary outcomes included protocol adherence, and 6-min walking test. We used risk ratios (RR) and mean differences to summarise the results. The risk of bias was assessed using RoB 2 tool. RESULTS We included 29 randomised trials for a total of 3508 patients. Median adherence to home-based prehabilitation programs was 82%. Home-based prehabilitation reduced the proportion of patients with postoperative complications (508/1322 [38.4%] vs 578/1335 [43.3%], risk ratio 0.84, 95% confidence interval [CI] 0.72-0.98, P=0.02, I2=44%, low certainty). After home-based prehabilitation, 6-min walking test performance was better compared with control (MD 28.2 m (95% CI 9.5-46.9; P<0.01, I2=48). Preoperative depression (MD -0.65, 95% CI -0.87 to -0.43; P<0.001, I2=0%), postoperative anxiety (MD -0.50, 95% CI -0.75 to -0.25; P<0.001, I2=0%, low certainty) and length of hospital stays (MD -0.32 days, 95% CI -0.61 to -0.03; P=0.03, I2=45%, low certainty) were lower with home-based prehabilitation. CONCLUSIONS Home-based prehabilitation reduced the proportion of patients with postoperative complications, but with low certainty of evidence. It also improved preoperative functional capacity, reduced hospital stays, depression and anxiety scores, with good adherence to the intervention. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42024591208).
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Affiliation(s)
- Filippo D'Amico
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Dormio
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Veronesi
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabio Guarracino
- Department of Cardiothoracic Anaesthesia and ICU, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Katia Donadello
- Department of Anaesthesia and Intensive Care B, Department of Surgery, Dentistry, Gynaecology and Pediatrics, University of Verona, AOUI-University Hospital Integrated Trust of Verona, Verona, Italy
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - Riccardo Rosati
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Pecorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Baldini
- Department of Health Science, University of Florence, Florence, Italy; Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Prehabilitation Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marina Pieri
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giovanni Landoni
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Turi
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Yoo M, Jang CW. Prehabilitation Research: A Bibliometric Analysis of Past Trends and Future Directions. Am J Phys Med Rehabil 2025; 104:357-363. [PMID: 39235947 DOI: 10.1097/phm.0000000000002611] [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: 09/07/2024]
Abstract
OBJECTIVE This study investigates the global research landscape of prehabilitation, identifying current trends, dominant disciplines, collaborative networks, and prominent articles in the field. DESIGN For our analysis, we employed the published prehabilitation literature indexed in the Web of Science Core Collection database, spanning from 2002 to 2022. In addition, we utilized CiteSpace (version 6.2; Drexel University), a widely used information visualization software to perform bibliometric analysis. RESULTS Analyzing 553 research articles, we observe a consistent upward trend in prehabilitation publication and citation activity. Interdisciplinary co-occurrence analysis highlights strong connections with fields such as surgery, rehabilitation, oncology, sports sciences, orthopedics, gastroenterology, and hepatology. Initially centered around postoperative outcomes in major abdominal surgeries, particularly for colorectal, pancreatic, and prostate cancers, prehabilitation research expanded to include thoracic surgeries, focusing on conditions like lung cancer and aortic valve replacement. Preoperative exercise remains a core area, with increasing interest in multimodal prehabilitation and its effectiveness based on patient group characteristics. North America and Western Europe emerge as primary contributors to prehabilitation research. CONCLUSIONS Current research concentrates on tailoring prehabilitation programs for specific groups, and broadening their geographical scope would enhance the studies, contributing valuable insights for medical practitioners shaping future research efforts.
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Affiliation(s)
- Myungeun Yoo
- From the Department of Rehabilitation Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea (MY); Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea (CWJ); and Command Center, Doheon Institute for Digital Innovation in Medicine, Hallym University Medical Center, Anyang, Republic of Korea (CWJ)
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Takenaka H, Kamiya M, Suzuki J. Prehabilitation Improves Early Outcomes in Lumbar Spinal Stenosis Surgery: A Pilot Randomized Controlled Trial. Clin Spine Surg 2025:01933606-990000000-00446. [PMID: 40035543 DOI: 10.1097/bsd.0000000000001779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 02/11/2025] [Indexed: 03/05/2025]
Abstract
STUDY DESIGN A pilot randomized controlled trial. OBJECTIVE To investigate the effects of a prehabilitation program on early postoperative outcomes in Japanese patients undergoing lumbar spinal stenosis (LSS) surgery. SUMMARY OF BACKGROUND DATA Prehabilitation has shown promise for improving postoperative outcomes in various surgical populations. However, its effectiveness in Japanese patients undergoing LSS surgery has not been previously studied. METHODS Thirty-two of 34 patients scheduled for LSS surgery (mean age: 69.3 y, 17 female) were randomly assigned to the prehabilitation group (15 patients) or control group (17 patients). The primary outcomes were the Oswestry Disability Index (ODI) and 6-minute walk distance (6MWD). The secondary endpoints were the visual analog scale (VAS) scores for back pain, leg pain, and numbness. The intervention group received a 20-30-minute educational session from a physical or occupational therapist using a pamphlet 1 month before surgery, while the control group received a pamphlet handout. Assessments were conducted 1 month before surgery (baseline); 1 day before surgery; and 1, 3, and 6 months postoperatively. RESULTS All patients underwent preoperative educational sessions. The prehabilitation group showed significant improvements in 6MWD at 3 months postoperatively compared with the control group (446.8±48.9 m vs. 384.3±58.3 m, P=0.01, Hedges' g=1.11). ODI scores at 1 month postoperatively were lower in the prehabilitation group (10.2±10.9 vs. 19.0±10.7, P=0.04, Hedges' g=-0.77). Low back pain VAS at 3 months postoperatively was also lower in the prehabilitation group (12.5±14.8 vs. 27.5±20.8, P=0.04, Hedges' g=0.75). No adverse events were reported in either of the groups. CONCLUSIONS Prehabilitation may enhance postoperative recovery and outcomes in patients undergoing surgery for LSS. Further research with a larger sample size is needed to establish the effectiveness of prehabilitation in this population.
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Affiliation(s)
- Hiroto Takenaka
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Shizuoka
- Department of Rehabilitation
| | - Mitsuhiro Kamiya
- Department of Orthopaedic Surgery, Kasugai Orthopedics and Asahi Hospital, Kasugai, Japan
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Nakamoto H, Fujimoto M, Nagata M, Hiroshi S, Sawamura S. Efficacy of Preoperative Exercise in Prehabilitation for Preventing Postoperative Sleep Disturbances and Pain: An Experimental Rat Model Study. Cureus 2025; 17:e79901. [PMID: 40171378 PMCID: PMC11959169 DOI: 10.7759/cureus.79901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2025] [Indexed: 04/03/2025] Open
Abstract
Background Postoperative sleep disturbances and pain are common, negatively impacting recovery and quality of life. While various preventive strategies exist, the role of preoperative exercise in mitigating these effects remains underexplored. Objective This study evaluates the efficacy of preoperative exercise as a prehabilitation strategy to reduce postoperative sleep disturbances and pain in a rat model. Methods Male Wistar rats were divided into three groups: postoperative pain (PO) without preoperative exercise (N-group), PO with preoperative exercise (P-group), and a sham-operated control (S-group). Sleep patterns, including sleep duration and quality, were analyzed using EEG over a 72-hour period, starting at 8:00 a.m. on the first day of the experiment. Additionally, pain thresholds were assessed using the von Frey and Hargreaves tests. Results Compared to the N-group, the P-group exhibited reduced wake time and increased non-rapid eye movement (NREM) sleep duration. Additionally, the N-group showed increased wake time and decreased NREM sleep duration compared to the S-group, whereas no significant differences were observed between the P- and S-groups. The thermal allodynia test indicated a higher pain threshold in the P-group than in the N-group, although both remained lower than the S-group. Conclusions Our study demonstrates the efficacy of preoperative exercise as a nonpharmacological intervention for reducing postoperative sleep disturbances and alleviating pain. These findings highlight the potential benefits of prehabilitation for patients undergoing surgery.
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Affiliation(s)
- Hirofumi Nakamoto
- Department of Anesthesiology, Teikyo University School of Medicine, Tokyo, JPN
| | - Moe Fujimoto
- Department of Anesthesiology, Teikyo University School of Medicine, Tokyo, JPN
| | - Megumi Nagata
- Department of Anesthesiology, Teikyo University School of Medicine, Tokyo, JPN
| | - Sekiyama Hiroshi
- Department of Anesthesiology, Teikyo University School of Medicine, Tokyo, JPN
| | - Shigehito Sawamura
- Department of Anesthesiology, Teikyo University School of Medicine, Tokyo, JPN
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van Oorschot HD, Hardillo JA, van Es RJJ, van den Broek GB, Takes RP, Halmos GB, de Jel DVC, Dirven R, Lacko M, Vaassen LAA, Hendrickx JJ, Oomens MAEM, Ghaeminia H, Jansen JC, Vesseur A, Bun R, Schwandt LQ, Krabbe CA, Klein Nulent TJW, Klijn RJ, van Bemmel AJM, Baatenburg de Jong RJ. Surgical Complications for Oral Cavity Cancer: Evaluating Hospital Performance. Laryngoscope 2025. [PMID: 39912197 DOI: 10.1002/lary.32033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 12/23/2024] [Accepted: 01/17/2025] [Indexed: 02/07/2025]
Abstract
OBJECTIVE Complications of oral cavity cancer (OCC) surgery have an impact on the quality of life. Therefore, evaluating hospital performance on complication rates can help identify best practices for improving the quality of OCC care. As patient and tumor characteristics also impact hospital results, case-mix adjustment should be considered to provide a valid hospital comparison. This study investigated hospital variation in the quality indicator "a complicated postoperative course" after OCC surgery. METHODS This population-based cohort included all first primary OCC patients diagnosed between 2018 and 2021 who were surgically treated with curative intent. A complicated postoperative course was defined as 30-day mortality, unplanned readmission, surgical complications requiring reintervention or prolonged hospital stay, or fistula formation. Hospital performance was analyzed using funnel plots with case-mix correction. RESULTS A total of 2,266 OCC patients could be included. The distribution of case-mix variables varied significantly between hospital populations. Nationally, a complicated postoperative course occurred in 13.9% and uncorrected hospital rates ranged from 2.7% to 31.1%. A WHO performance score ≥2, cT3-T4 tumors, and floor-of-mouth tumors were associated with an increased risk of a complicated postoperative course, and non-squamous cell carcinoma with a decreased risk. Significant outliers remained after case-mix correction for patient, tumor, and treatment characteristics. CONCLUSION Complications after OCC surgery are prevalent, especially regarding extensive tumors and surgery. To identify best practices in OCC surgery, hospital performance on a complicated postoperative course should be adjusted for case-mix and treatment variables. Providing feedback on hospital performance for complications can instigate improvement plans for better outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 2025.
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Affiliation(s)
- Hanneke Doremiek van Oorschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Jose Angelito Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - Robert J J van Es
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert Paul Takes
- Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gyorgy Bela Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Dominique Valerie Clarence de Jel
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lauretta Anna Alexandra Vaassen
- Department of Cranio-maxillofacial surgery, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan-Jaap Hendrickx
- Department of Otorhinolaryngology, Head and Neck Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Hossein Ghaeminia
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Annemarie Vesseur
- Department of Otolaryngology, Head and Neck Surgery, Elisabeth Tweesteden Ziekenhuis Tilburg, Tilburg, The Netherlands
| | - Rolf Bun
- Department of Oral and Maxillofacial Surgery/Head and Neck Oncology Noordwest Hospital group, Alkmaar en Dijklander Hospital, Hoorn, The Netherlands
| | - Leonora Q Schwandt
- Department of Oral and Maxillofacial Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Christiaan A Krabbe
- Department of Oral and Maxillofacial Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Thomas J W Klein Nulent
- Department of Oral and Maxillofacial Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Reinoud J Klijn
- Department of Oral and Maxillofacial and Head and Neck Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Alexander J M van Bemmel
- Department of Otorhinolaryngology and Head and Neck Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Robert Jan Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
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11
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Pavlović M, Matko Š, Prüfer F, Löfler S, Fischer MJ, Grote V, Šarabon N. Health-Related Quality of Life, Body Mass Index and the 10-Metre Walk Test in Patients Awaiting Total Knee or Hip Arthroplasty: A Cross-Sectional Data Analysis with Matched Controls. Life (Basel) 2025; 15:231. [PMID: 40003642 PMCID: PMC11857075 DOI: 10.3390/life15020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 01/31/2025] [Accepted: 02/02/2025] [Indexed: 02/27/2025] Open
Abstract
The study compares the body mass index (BMI), 10-m walk test results, and self-rated health-related quality of life (HRQoL) of patients awaiting total knee or hip arthroplasty with age and sex-matched controls. Additionally, we investigated relationships between these variables to better understand how mobility impairments and HRQoL contribute to the need for surgical intervention. Forty-three patients (age: 66.7 ± 8.7 years) awaiting total knee arthroplasty (n = 23) or total hip arthroplasty (n = 20) and 54 healthy control individuals (age: 65.6 ± 1.5 years) participated in this study. Weight and height were measured, the BMI was calculated, the 10 m walk test was performed, and HRQoL was assessed using the EQ-5D-5L questionnaire. Patients had a significantly higher BMI than controls (p = 0.037), with the majority of both groups classified as overweight or obese (patients, 86%; controls, 73%). Patients also walked significantly more slowly than controls (p < 0.001). HRQoL was significantly lower in patients across all dimensions (p < 0.001), with the greatest impairments observed in mobility, usual activities, and pain. Significant but weak correlations (p = 0.001-0.042, rs = 0.31-0.48) were found between the HRQoL, BMI, and 10 m walk test results. These findings confirm that patients awaiting total knee or hip arthroplasty exhibit an increased BMI, reduced locomotor function, and impaired HRQoL, highlighting the extent of functional limitations in individuals with end-stage osteoarthritis. The strong association between mobility impairments and HRQoL further underscores the impact of osteoarthritis on daily life and the increasing need for surgical intervention.
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Affiliation(s)
- Monika Pavlović
- Department of Prosthetics, Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Kinesiology, Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia
| | - Špela Matko
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
- Institute for Outcomes Research, Center for Medical Data Science, Medical University of Vienna, 1090 Vienna, Austria
| | - Ferdinand Prüfer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
- Physiko & Rheumatherapie, Institute for Physical Medicine and Rehabilitation, 3100 St. Pölten, Austria
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
- Rehabilitation Center Kitzbühel, 6370 Kitzbühel, Austria
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
| | - Nejc Šarabon
- Department of Kinesiology, Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
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12
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Daniels AH, Singh M, Knebel A, Thomson C, Kuharski MJ, De Varona A, Nassar JE, Farias MJ, Diebo BG. Preoperative Optimization Strategies in Elective Spine Surgery. JBJS Rev 2025; 13:01874474-202502000-00002. [PMID: 39903820 DOI: 10.2106/jbjs.rvw.24.00210] [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: 02/06/2025]
Abstract
» Although spine surgery is effective in reducing pain and improving functional status, it is associated with unacceptably high rates of complications, thus necessitating comprehensive preoperative patient optimization.» Numerous risk factors that can impact long-term surgical outcomes have been identified, including malnutrition, cardiovascular disease, osteoporosis, substance use, and more.» Preoperative screening and personalized, evidence-based interventions to manage medical comorbidities and optimize medications can enhance clinical outcomes and improve patient satisfaction following spine surgery.» Multidisciplinary team-based approaches, such as enhanced recovery after surgery protocols and multidisciplinary conferences, can further facilitate coordinated care from across specialties and reduce overall hospital length of stay.
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Affiliation(s)
- Alan H Daniels
- Department of Orthopedics, Brown University, Providence, Rhode Island
| | - Manjot Singh
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Ashley Knebel
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cameron Thomson
- Department of Orthopedics, Brown University, Providence, Rhode Island
| | - Michael J Kuharski
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abel De Varona
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Joseph E Nassar
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Michael J Farias
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- Department of Orthopedics, Brown University, Providence, Rhode Island
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13
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Niezgoda N, Chomiuk T, Mamcarz A, Śliż D. Physical Activity before and After Bariatric Surgery. Metab Syndr Relat Disord 2025; 23:1-12. [PMID: 39361501 DOI: 10.1089/met.2024.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Abstract
Lifestyle changes including reduced calorie intake and increased physical activity (PA) improve the prognosis associated with bariatric surgery (BS) and metabolic indices. Early implementation of exercise leads to improved physical performance, better glycemic control and lipid profile, reduces the risks associated with anesthesia, and accelerates recovery from surgery. Undertaking systematic exercise after BS is associated with a better quality of life, improves insulin sensitivity, results in additional weight loss, reduces adverse effects on bone mass, and results in better body composition. The aim of this review was to summarize recommendations for physical activity in patients undergoing BS and to highlight the key role of physical activity in this patient group.
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Affiliation(s)
- Natalia Niezgoda
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Tomasz Chomiuk
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Daniel Śliż
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
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14
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Kann MR, Estes E, Pugazenthi S, Barpujari A, Mohan V, Rogers JL, Kashyap JA, Hardi A, Graffeo CS. The Impact of Surgical Prehabilitation on Postoperative Patient Outcomes: A Systematic Review. J Surg Res 2025; 306:165-181. [PMID: 39778235 DOI: 10.1016/j.jss.2024.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 10/22/2024] [Accepted: 11/16/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION Prehabilitation (preoperative rehabilitation) encompasses a range of patient health driven interventions with the potential to enhance surgical outcomes. This systematic review aims to assess the efficacy of prehabilitation on postoperative outcomes across surgical specialties, focusing on physical functionality and postoperative length of stay (LOS). METHODS Medline, Embase, CINAHL Plus, Cochrane Library, Scopus, and Clinicaltrials.gov databases were queried using the search terms prehabilitation, surgery, and related synonyms. Included publications were original, English-language, full-text studies conducted in the US with a cohort of ≥5 patients undergoing prehabilitation. After title (n = 1817), abstract (n = 1059), and full-text (n = 411) screens, 26 articles met inclusion criteria. RESULTS Of 26 included articles, 30.8% (n = 8) assessed oncologic surgeries, 34.6% (n = 9) assessed orthopedic surgeries, 19.2% (n = 5) assessed general surgery procedures, and 15.4% (n = 4) assessed cardiac, colorectal, urologic, and transplant surgeries. Physical function was the most common assessed primary outcome, with 46.2% (n = 12) of studies measuring physical activity, functional status, range of motion, or muscle strength. The outcomes of six-meter walk test, sit-to-stand test, and LOS were reported in 26.9% (n = 7), 23.1% (n = 6), and 19.2% (n = 5) of studies, respectively. Three studies found a significant improvement in the six-meter walk test, and four studies demonstrated a significant improvement in sit-to-stand test after prehabilitation. LOS outcomes had varied results across studies. CONCLUSIONS Prehabilitation interventions have the potential to improve postoperative outcomes, including physical function and LOS in surgical patients. Further research is necessary to identify the most efficacious prehabilitation protocols and determine their optimal impact within diverse surgical subpopulations.
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Affiliation(s)
- Michael R Kann
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Emily Estes
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas
| | - Sangami Pugazenthi
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Vamsi Mohan
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas
| | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jayanth A Kashyap
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Angela Hardi
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
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15
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Genet B, Cohen-Bittan J, Nicolas M, Bonnet-Zamponi D, Naline C, Ouafi-Hendel D, François V, Cabral C, Cloppet A, Davy C, Boddaert J, Zerah L. Feasibility of a Multimodal Prehabilitation Program before Elective Knee and Hip Arthroplasty in Older Adults. J Am Med Dir Assoc 2025; 26:105345. [PMID: 39521022 DOI: 10.1016/j.jamda.2024.105345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/30/2024] [Accepted: 09/30/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVES Hip osteoarthritis and knee osteoarthritis cause significant disability and pain in older adults, often leading to hip or knee replacement surgery. Prehabilitation programs have been established for these surgeries, but there are few programs for orthogeriatrics. We evaluated the feasibility of a new multimodal prehabilitation program (MPP) for older adults before hip or knee replacement due to arthrosis: the Prehabilitation for Os (PRE4OS) study. DESIGN We conducted a multicenter feasibility study in the Greater Paris area. SETTING AND PARTICIPANTS Eligible adults were aged ≥75 years old awaiting hip or knee replacement with at least a 6-week delay before surgery and able to participate in the MPP follow-up. The MPP included weekly hospital sessions providing nutritional, psychological, functional, and cognitive support, along with weekly home sessions featuring physiotherapist visits. METHODS The primary outcome was at least 80% of 1-day hospital (ODH) sessions performed by 80% of participants. Secondary outcomes included intervention achievement, quality of life, and nutritional and functional status changes. Participant's satisfaction was qualitatively assessed via structured phone interviews presurgery and at 30 days postsurgery. RESULTS From September 2021 to September 2023, a total of 27 individuals participated in the PRE4OS study. The mean (SD) age was 83 (4.3) years, with 7 males (26%) and median baseline Activities of Daily Living score 5.5 (interquartile range 5.5-6.0). Surgeries were for insertion of hip prosthesis in 17 participants (63%) and knee prosthesis in 10 (37%). The primary outcome was achieved in 89% of participants, with comparable rates for hip and knee prostheses. In total, 60% of participants rated the MPP as "excellent" presurgery and 100% at 30 days postsurgery, expressing a willingness to recommend the protocol to a friend or family. CONCLUSION AND IMPLICATIONS The MPP was feasible for individuals before hip or knee replacement and was well received. Further randomized trials are needed to assess its clinical impact.
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Affiliation(s)
- Bastien Genet
- Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Equipe PEPITES, Sorbonne Université, INSERM, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France.
| | - Judith Cohen-Bittan
- Département de Gériatrie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Michaël Nicolas
- Département de Gériatrie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Dominique Bonnet-Zamponi
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, France; Observatoire des médicaments, dispositifs médicaux, Innovations thérapeutiques d'Île-de-France (OMéDIT IDF), Paris, France
| | - Charlotte Naline
- Centre Hospitalier de Versailles, Département de Gériatrie, Unité Péri-Opératoire Gériatrique, Le Chesnay, France
| | - Dehbia Ouafi-Hendel
- Centre Hospitalier Sud Francilien, Département de Gériatrie, Unité Péri-Opératoire Gériatrique, Corbeil-Essonnes, France
| | - Véronique François
- Département de Gériatrie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | | | | | - Claire Davy
- Agence Régionale de Santé d'Ile de France, Saint-Denis, France
| | - Jacques Boddaert
- Département de Gériatrie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France; Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), Sorbonne Université, INSERM, Paris, France
| | - Lorène Zerah
- Département de Gériatrie, Hôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France; Institut Pierre Louis d'Épidémiologie et de Santé Publique, Equipe PEPITES, Sorbonne Université, INSERM, Paris, France
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16
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Yan H, Shuying C, Yuege L, Han K. Barriers and Facilitators Related to Undertaking Physical Activities in Colorectal Cancer Patients: A Scoping Review. Oncol Rev 2024; 18:1360480. [PMID: 39309606 PMCID: PMC11414545 DOI: 10.3389/or.2024.1360480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/22/2024] [Indexed: 09/25/2024] Open
Abstract
Background Colorectal cancer (CRC) and its treatments cause significant acute, chronic, or latent adverse effects, leading to decreased physical function and quality of life. Robust evidence supports the positive effects of physical activity (PA) on various health outcomes in CRC patients. However, there is limited understanding regarding the factors that influence PA engagement, including facilitators, preferences, and barriers in this population. Purpose This scoping review aims to document the breadth and depth of literature concerning the various aspects of PA participation among patients with CRC. We conducted a scoping review of PA among CRC patients. Methods We searched several databases, including PubMed, Web of Science, Embase, and Cochrane, from their inception to 25 July 2023. Multiple reviewers were involved in all screening and data abstractions. The search yielded 834 individual citations after removing duplicates. After screening the titles and abstracts, 20 articles underwent full-text review, and 11 were included. Results Our research findings indicate that among CRC patients, the most prevalent facilitators/preferences for PA are understanding its importance and perceiving its benefits, whereas treatment-related effects and lack of time are the most common barriers. Conclusion CRC patients have unique facilitators and barriers concerning PA. Further research and clinical interventions are required to support and encourage this population to participate in and maintain regular PA.
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Affiliation(s)
- Hu Yan
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Chang Shuying
- Henan Provincial People’s Hospital, Zhengzhou, China
| | - Li Yuege
- School of Nursing and Health, Henan University, Kaifeng, China
| | - Kong Han
- School of Nursing and Health, Henan University, Kaifeng, China
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17
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Altuwaijri T. Prehabilitation to Enhance Vascular Surgery Outcomes: A Narrative Review. Cureus 2024; 16:e70200. [PMID: 39323542 PMCID: PMC11424123 DOI: 10.7759/cureus.70200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2024] [Indexed: 09/27/2024] Open
Abstract
Prehabilitation, an emerging strategy, prepares patients for elective surgery by encouraging healthy behaviors, including physical exercise and healthy nutrition, while providing psychological support, to improve postoperative outcomes and foster healthier lifestyles. Despite growing interest, there is little research on prehabilitation. Specifically, studies involving prehabilitation in vascular surgery are heterogeneous with small sample sizes. This review aimed to investigate the reported positive impact of prehabilitation on vascular surgery patients, discuss prehabilitation models, highlight prehabilitation program-associated challenges, and suggest appropriate interventions. Prehabilitation improves physical fitness, reduces postoperative complications, and enhances overall recovery. Multimodal prehabilitation programs can positively impact vascular surgery patients, with benefits including improved cardiovascular fitness, reduced postoperative complications, shorter postoperative hospital stays, enhanced overall recovery, and improved quality of life. The currently reported prehabilitation programs are heterogeneous, with limitations regarding patient adherence and lack of long-term outcomes, posing challenges to their widespread adoption. Overall, prehabilitation shows promise for improving vascular surgery outcomes and fostering long-term healthy behaviors. The systematic implementation of prehabilitation in vascular surgery care pathways, overcoming reported limitations, and integrating multimodal prehabilitation into routine preoperative care hold potential benefits. This review underscores the need for high-quality research to establish best practices in prehabilitation and integrate them into the standard of care for vascular surgery patients.
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Affiliation(s)
- Talal Altuwaijri
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, SAU
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18
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Eubanks JE, Cupler ZA, Gliedt JA, Bejarano G, Skolasky RL, Smeets RJEM, Schneider MJ. Preoperative spinal education for lumbar spinal stenosis: A feasibility study. PM R 2024; 16:992-1000. [PMID: 38578142 DOI: 10.1002/pmrj.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/19/2023] [Accepted: 12/15/2023] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Lumbar spinal stenosis (LSS) is a leading cause of chronic musculoskeletal pain among older adults. A common and costly intervention for the treatment of LSS is lumbar decompression with or without fusion (LSS surgery), which has mixed outcomes among patients. Prehabilitation is a strategy designed to optimize the consistency of positive surgical outcomes and promote patient self-efficacy, while attempting to mitigate postoperative complications. No efforts have investigated the prehabilitation strategies specifically for patients undergoing LSS surgery. OBJECTIVE To determine the feasibility of delivery and acceptability by participants of a novel prehabilitation intervention for patients undergoing LSS surgery. DESIGN Feasibility study. SETTING Outpatient orthopedic clinic at an academic medical center. PARTICIPANTS Patients at least 50 years of age, who were scheduled for LSS surgery between October 2020 and October 2021. INTERVENTION PreOperative Spinal Education for Lumbar Spinal Stenosis (POSE-LSS), is a novel multimodal, education-focused, time-efficient prehabilitation program for patients undergoing LSS surgery. Participants received the following: (1) Educational booklet and video; (2) In-person physical therapy (PT) session; and (3) Telemedicine visit with a physiatrist. MAIN OUTCOME MEASURE(S) The primary outcomes of interest were feasibility and acceptability of intervention by participants. Key potential surgical outcomes were length of stay and discharge disposition. RESULTS POSE-LSS was completed by all eligible participants enrolled (n = 15) indicating feasibility and acceptability. Potential effectiveness measures including length of stay and discharge disposition were positively associated with the POSE-LSS intervention. CONCLUSIONS This study demonstrates that a novel prehabilitation intervention is feasible, acceptable, and appears positively associated with important short-term measures of postoperative recovery that may impact the trajectory of patient care following LSS surgery.
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Affiliation(s)
- James E Eubanks
- Department of Orthopaedics and Physical Medicine, Division of Physical Medicine and Rehabilitation, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Geronimo Bejarano
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Richard L Skolasky
- Orthopaedic Surgery and Physical Medicine & Rehabilitation, Surgical Outcomes Research Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rob J E M Smeets
- Pain in Motion International Research Group (PiM), Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University and CIR Revalidatie, Eindhoven, The Netherlands
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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19
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Strijker D, Drager L, van Asseldonk M, Atsma F, van den Berg M, van Daal E, van Heusden-Scholtalbers L, Meijerink J, Servaes P, Teerenstra S, Verlaan S, van den Heuvel B, van Laarhoven K. Multimodal prehabilitation (Fit4Surgery) in high-impact surgery to enhance surgical outcomes: Study protocol of F4S PREHAB, a single center stepped wedge trial. PLoS One 2024; 19:e0303829. [PMID: 38968183 PMCID: PMC11226070 DOI: 10.1371/journal.pone.0303829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/30/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND High-impact surgery imposes a significant physiological and functional burden and is associated with substantial postoperative morbidity. Multimodal prehabilitation has demonstrated a reduction in postoperative complications and enhanced functional recovery, mainly in abdominal cancer surgery. Common preoperative risk factors shared among patients undergoing high-impact surgery, extending beyond abdominal cancer surgery procedures, suggest the relevance of multimodal prehabilitation to a broader patient population. This stepped wedge trial primarily aims to examine the hospital-wide effect of multimodal prehabilitation, compared to standard preoperative care, on the occurrence and severity of postoperative complications. Secondary and tertiary endpoints include length of hospital stay, physical fitness, nutritional status, mental health, intoxications, and cost-effectiveness of the intervention. METHODS The Fit4Surgery (F4S) PREHAB trial is a monocenter stepped wedge trial in an academic hospital. Adult patients, divided into 20 health clusters based on specific diagnoses, will be assessed for eligibility and receive usual preoperative care or multimodal prehabilitation. Patient enrollment commenced in March 2021 and continues up to and including April 2024. The intervention consists of a high-intensity exercise program, a nutritional intervention, psychological support, and smoking and alcohol cessation. The primary outcome will be measured by the Clavien-Dindo classification (grade II or higher) and the Comprehensive Complication Index (CCI). DISCUSSION Multimodal prehabilitation potentially reduces postoperative complications and enhances functional recovery. This is the first study to determine the hospital-wide effect and cost-effectiveness of multimodal prehabilitation in patients across various surgical specialties.
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Affiliation(s)
- Dieuwke Strijker
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luuk Drager
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique van Asseldonk
- Department of Gastroenterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Femke Atsma
- Department of Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Manon van den Berg
- Department of Gastroenterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elke van Daal
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jeroen Meijerink
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Petra Servaes
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sjors Verlaan
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Baukje van den Heuvel
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kees van Laarhoven
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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20
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Shen Y, Cong Z, Ge Q, Huang H, Wei W, Wang C, Jiang Z, Wu Y. Effect of nutrition-based prehabilitation on the postoperative outcomes of patients with esophagogastric cancer undergoing surgery: A systematic review and meta-analysis. Cancer Med 2024; 13:e70023. [PMID: 39001679 PMCID: PMC11245637 DOI: 10.1002/cam4.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/17/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Meta-analyses have primarily focused on the effects of exercise-based prehabilitation on postoperative outcomes and ignored the role of nutritional intervention. In this study, we filled this gap by investigating the effect of nutrition-based prehabilitation on the postoperative outcomes of patients who underwent esophagectomy and gastrectomy. METHODS Five electronic databases, namely, PubMed, the Web of Science, Embase, Cochrane Library, and CINAHL, were searched. Adults diagnosed with esophagogastric cancer who were scheduled to undergo surgery and had undergone uni- or multimodal prehabilitation, with at least a week of mandatory nutritional intervention, were included. Forest plots were used to extract and visualize the data from the included studies. The occurrence of any postoperative complication was considered the primary endpoint. RESULTS Eight studies met the eligibility criteria, with five randomized controlled trials (RCTs) and three cohort studies. In total, 661 patients were included. Any prehabilitation, that is, unimodal (only nutrition) and multimodal prehabilitation, collectively decreased the risk of any postoperative complication by 23% (95% confidence interval [CI] = 0.66-0.90). A similar effect was exclusively observed for multimodal prehabilitation (risk ratio [RR] = 0.78, 95% CI = 0.66-0.93); however, it was not significant for unimodal prehabilitation. Any prehabilitation significantly decreased the length of hospital stay (LOS) (weighted mean difference = -0.77, 95% CI = -1.46 to -0.09). CONCLUSIONS Nutrition-based prehabilitation, particularly multimodal prehabilitation, confers protective effects against postoperative complications after esophagectomy and gastrectomy. Our findings suggest that prehabilitation slightly decreases LOS; however, the finding is not clinically significant. Therefore, additional rigorous RCTs are warranted for further substantiation.
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Affiliation(s)
- Yi Shen
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhuangzhuang Cong
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qiyue Ge
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hairong Huang
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China
| | - Wei Wei
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China
| | - Changyong Wang
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China
| | - Zhisheng Jiang
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China
| | - Yuheng Wu
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
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21
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Shields LBE, Clark L, Reed J, Tichenor S. Implementing a nurse-led prehabilitation program for patients undergoing spinal surgery. Nursing 2024; 54:42-50. [PMID: 38913927 DOI: 10.1097/nsg.0000000000000025] [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: 06/26/2024]
Abstract
ABSTRACT Prehabilitation, or "prehab," helps patients optimize strength, function, and nutrition before surgery. This evidence-based practice project presents strategies for implementing a prehab program to prepare patients for spinal surgery. Nurses play an integral role in educating patients preoperatively about the myriad lifestyle changes associated with spinal surgery.
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Affiliation(s)
- Lisa B E Shields
- Lisa Shields is a medical research associate at Norton Neuroscience Institute, Norton Healthcare. Lisa Clark is the program manager for Neurosurgery at Norton Healthcare. Jenna Reed is the rehabilitation supervisor at the Norton Neurosciences and Spine Rehabilitation Center. Stephanie Tichenor is a neurosurgery nurse practitioner at the Norton Neuroscience Institute
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22
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Jankowski PP, Tretiakov PS, Onafowokan OO, Das A, Imbo B, Krol O, Joujon-Roche R, Williamson T, Dave P, Mir J, Owusu-Sarpong S, Passias PG. Assessing the effects of prehabilitation protocols on post-operative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes? Spine Deform 2024; 12:1107-1113. [PMID: 38538932 DOI: 10.1007/s43390-024-00845-8] [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] [Received: 11/16/2023] [Accepted: 02/13/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE To investigate the effect of a prehabilitation program on peri- and post-operative outcomes in adult cervical deformity (CD) surgery. METHODS Operative CD patients ≥ 18 years with complete baseline (BL) and 2-year (2Y) data were stratified by enrollment in a prehabilitation program beginning in 2019. Patients were stratified as having undergone prehabilitation (Prehab+) or not (Prehab-). Differences in pre and post-op factors were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. RESULTS 115 patients were included (age: 61 years, 70% female, BMI: 28 kg/m2). Of these patients, 57 (49%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI, and frailty. Surgically, Prehab+ were able to undergo longer procedures (p = 0.017) with equivalent EBL (p = 0.627), and shorter SICU stay (p < 0.001). Post-operatively, Prehab+ patients reported greater reduction in pain scores and greater improvement in quality of life metrics at both 1Y and 2Y than Prehab- patients (all p < 0.05). Prehab+ patients reported significantly less complications overall, as well as less need for reoperation (all p < 0.05). CONCLUSION Introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling patients to undergo longer surgeries with lessened risk of peri- and post-operative complications.
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Affiliation(s)
| | - Peter S Tretiakov
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Oluwatobi O Onafowokan
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Ankita Das
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Bailey Imbo
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Oscar Krol
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Rachel Joujon-Roche
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Tyler Williamson
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Pooja Dave
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Jamshaid Mir
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Stephane Owusu-Sarpong
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Peter G Passias
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
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23
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Klimke R, Ott A, Romero CS, Berendes A, Urman RD, Luedi MM, Ashok V. Transitional Pain Service: An Update. Curr Pain Headache Rep 2024; 28:457-464. [PMID: 38530574 PMCID: PMC11156754 DOI: 10.1007/s11916-024-01239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE OF REVIEW Chronic Postsurgical Pain (CPSP) and the risk for long-term opioid dependency are known complications following major surgery. The idea of Transitional Pain Service (TPS) has been introduced as an interdisciplinary setting to manage pain in the perioperative continuum. We expand on the basic framework and principles of TPS and summarize the current evidence of the TPS and possible interventions to adress postoperative pain. Areas of future work in TPS-related research are discussed. RECENT FINDINGS Several studies support the effectiveness of TPS in reducing opioid consumption in the perioperative period and following discharge. Some studies also show an improvement in functional outcome with TPS with patients reporting lower pain severity and pain interference. The TPS aims to halt the progress of acute postoperative pain to CPSP by providing longitudinal support with patient-centered care. While some studies suggest a positive impact of TPS implementation in terms of reduction in postoperative opioid consumption and improvement of some functional outcomes, direct evidence in terms of reduction in the incidence of CPSP is still missing. The cost-effectiveness of TPS and the expansion of TPS through e-health services and digital applications also need to be evaluated.
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Affiliation(s)
- Ruben Klimke
- Department of Anaesthesiology Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Alexander Ott
- Department of Anaesthesiology Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Carolina S Romero
- Department of Anaesthesiology and Critical Care, Hospital General Universitario de Valencia, Valencia, Spain
- Research Methods Department, Universidad Europea de Valencia, Valencia, Spain
| | - Andrea Berendes
- Center for Palliative Care Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Richard D Urman
- Department of Anaesthesiology, College of Medicine, The Ohio State University, Columbus, OH, 43210, United States of America
| | - Markus M Luedi
- Department of Anaesthesiology Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Vighnesh Ashok
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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24
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Jack S, Andritsch E, Joaquim A, Kreissl M, Locati L, Netea-Maier R, Reverter J, Elisei R. Current landscape and support for practical initiation of oncological prehabilitation translatable to thyroid cancer: A position paper. Heliyon 2024; 10:e30723. [PMID: 38813200 PMCID: PMC11133508 DOI: 10.1016/j.heliyon.2024.e30723] [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: 06/12/2023] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Despite a growing body of evidence for the effectiveness of prehabilitation, the uptake of prehabilitation in Europe remains low. Contributing factors range from limited awareness and understanding of prehabilitation to a lack of supporting infrastructure and reimbursement challenges. In this position paper, the authors propose a new comprehensive definition of prehabilitation and identify differentiated thyroid cancer as a type of cancer particularly well-suited for prehabilitation. To support clinicians with the implementation of prehabilitation programs in their clinics, the authors discuss the following practical solutions: a) find the most appropriate prehabilitation program for each patient; b) raise awareness among peers; c) develop evidence to demonstrate the effectiveness of prehabilitation; d) expand the interdisciplinary team; e) expand your network and make use of existing assets; f) utilize learnings from the COVID-19 pandemic.
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Affiliation(s)
- S. Jack
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - E. Andritsch
- Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036, Graz, Austria
| | - A. Joaquim
- ONCOMOVE®, Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
| | - M.C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto von Guericke University, Universitatsplätz 2, 39106, Magdeburg, Germany
| | - L. Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, S. da Nuova, 65, 27100, Pavia, PV, Italy
- Medical Oncology Unit, IRCCS ICS, Maugeri, Via Salvatore Maugeri, 10, 27100 Pavia PV, Italy
| | - R.T. Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 28, 6525, GA, Nijmegen, the Netherlands
| | - J.L. Reverter
- Endocrinology and Nutrition Department, Germans Trias i Pujol University Hospital, Universidad Autónoma de Barcelona, Placa Civica, 08193, Bellaterra, Barcelona, Spain
| | - R. Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126, Pisa, PI, Italy
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25
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Grasso G, Noto M, Pescatori L, Sallì M, Kim HS, Teresi G, Torregrossa F. Enhanced Recovery after Cranial Surgery in Elderly: A Review. World Neurosurg 2024; 185:e1013-e1018. [PMID: 38467372 DOI: 10.1016/j.wneu.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) is a multidisciplinary approach aimed at reducing the length of hospital stay, improving patient outcomes, and reducing the overall cost of care. Although ERAS protocols have been widely adopted in various surgical fields, their application in cranial surgery remains relatively limited. METHODS Considering that the aging of the population presents significant challenges to healthcare systems, and there is currently no ERAS protocol available for geriatric patients over the age of 65 requiring cranial surgery, this article proposes a new ERAS protocol for this population by analyzing successful ERAS protocols and optimal perioperative care for geriatric patients described in the literature. RESULTS Our aim is to develop a feasible, safe, and effective protocol for geriatric patients undergoing elective craniotomy, which includes preoperative, intraoperative, and postoperative assessments and management, as well as outcome measures. CONCLUSIONS This multidisciplinary and evidence-based ERAS protocol has the potential to reduce perioperative morbidity, improve functional recovery, and enhance postoperative outcomes after cranial surgery in elderly. Further research will be necessary to establish strict guidelines.
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Affiliation(s)
- Giovanni Grasso
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
| | - Manfredi Noto
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | | | - Marcello Sallì
- Rehabilitation Medicine Outpatient Department, A.S.P. Palermo, Palermo, Italy
| | - Hyeun-Sung Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, South Korea
| | - Gaia Teresi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Fabio Torregrossa
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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26
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Passias PG, Tretiakov PS, Onafowokan OO, Galetta M, Lorentz N, Mir JM, Das A, Dave P, Lafage R, Yee T, Diebo B, Vira S, Jankowski PP, Hockley A, Daniels A, Schoenfeld AJ, Mummaneni P, Paulino CB, Lafage V. The Evolution of Enhanced Recovery After Surgery: Assessing the Clinical Benefits of Developments Within Enhanced Recovery After Surgery Protocols in Adult Cervical Deformity Surgery. Clin Spine Surg 2024; 37:182-187. [PMID: 38637915 DOI: 10.1097/bsd.0000000000001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To investigate the impact of evolving Enhanced Recovery After Surgery (ERAS) protocols on outcomes after cervical deformity (CD) surgery. BACKGROUND ERAS can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, there remains a paucity of literature assessing how developments have impacted outcomes after adult CD surgery. METHODS Patients with operative CD 18 years or older with pre-baseline and 2 years (2Y) postoperative data, who underwent ERAS protocols, were stratified by increasing implantation of ERAS components: (1) early (multimodal pain program), (2) intermediate (early protocol + paraspinal blocks, early ambulation), and (3) late (early/intermediate protocols + comprehensive prehabilitation). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors, and complication rates were assessed through Bonferroni-adjusted means comparison analysis. RESULTS A total of 131 patients were included (59.4 ± 11.7 y, 45% females, 28.8 ± 6.0 kg/m 2 ). Of these patients, 38.9% were considered "early," 36.6% were "intermediate," and 24.4% were "late." Perioperatively, rates of intraoperative complications were lower in the late group ( P = 0.036). Postoperatively, discharge disposition differed significantly between cohorts, with late patients more likely to be discharged to home versus early or intermediate cohorts [χ 2 (2) = 37.973, P < 0.001]. In terms of postoperative disability recovery, intermediate and late patients demonstrated incrementally improved 6 W modified Japanese Orthopedic Association scores ( P = 0.004), and late patients maintained significantly higher mean Euro-QOL 5-Dimension Questionnaire and modified Japanese Orthopedic Association scores by 1 year ( P < 0.001, P = 0.026). By 2Y, cohorts demonstrated incrementally increasing SWAL-QOL scores (all domains P < 0.028) domain scores versus early or intermediate cohorts. By 2Y, incrementally decreasing reoperation was observed in early versus intermediate versus late cohorts ( P = 0.034). CONCLUSIONS The present study demonstrates that patients enrolled in an evolving ERAS program demonstrate incremental improvement in preoperative optimization and candidate selection, greater likelihood of discharge to home, decreased postoperative disability and dysphasia burden, and decreased likelihood of intraoperative complications and reoperation rates.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute
| | - Peter S Tretiakov
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute
| | - Oluwatobi O Onafowokan
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute
| | - Matthew Galetta
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute
| | - Nathan Lorentz
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute
| | - Jamshaid M Mir
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute
| | - Ankita Das
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute
| | - Pooja Dave
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute
| | - Renaud Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Timothy Yee
- Department of Neurosurgery, University of California San Francisco, CA
| | - Bassel Diebo
- Department of Orthopedic Surgery, The Warren Alpert School of Medicine, Brown University, RI
| | - Shaleen Vira
- Departments of Orthopedic and Neurosurgery, Banner Health, Phoenix, AZ
| | - Pawel P Jankowski
- Department of Neurosurgery, Hoag Neurosciences Institute, Irvine, CA
| | - Aaron Hockley
- Department of Neurological Surgery, University of Alberta, Edmonton, AB, Canada
| | - Alan Daniels
- Department of Orthopedic Surgery, The Warren Alpert School of Medicine, Brown University, RI
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Praveen Mummaneni
- Department of Neurosurgery, University of California San Francisco, CA
| | - Carl B Paulino
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
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27
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Ling RR, Ueno R, Alamgeer M, Sundararajan K, Sundar R, Bailey M, Pilcher D, Subramaniam A. FRailty in Australian patients admitted to Intensive care unit after eLective CANCER-related SURGery: a retrospective multicentre cohort study (FRAIL-CANCER-SURG study). Br J Anaesth 2024; 132:695-706. [PMID: 38378383 DOI: 10.1016/j.bja.2024.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The association between frailty and short-term and long-term outcomes in patients receiving elective surgery for cancer remains unclear, particularly in those admitted to the ICU. METHODS In this multicentre retrospective cohort study, we included adults ≥16 yr old admitted to 158 ICUs in Australia from January 1, 2018 to March 31, 2022 after elective surgery for cancer. We investigated the association between frailty and survival time up to 4 yr (primary outcome), adjusting for a prespecified set of covariates. We analysed how this association changed in specific subgroups (age categories [<65, 65-80, ≥80 yr], and those who survived hospitalisation), and over time by splitting the survival information at monthly intervals. RESULTS We included 35,848 patients (median follow-up: 18.1 months [inter-quartile range: 8.3-31.1 months], 19,979 [56.1%] male, median age 69.0 yr [inter-quartile range: 58.8-76.0 yr]). Some 3502 (9.8%) patients were frail (defined as clinical frailty scale ≥5). Frailty was associated with lower survival (hazard ratio: 1.72, 95% confidence interval [CI]: 1.59-1.86 compared with clinical frailty scale ≤4); this was concordant across several sensitivity analyses. Frailty was most strongly associated with mortality early on in follow-up, up to 10 months (hazard ratio: 1.39, 95% CI: 1.03-1.86), but this association plateaued, and its predictive capacity subsequently diminished with time up until 4 yr (1.96, 95% CI: 0.73-5.28). Frailty was associated with similar effects when stratified based on age, and in those who survived hospitalisation. CONCLUSIONS Frailty was associated with poorer outcomes after an ICU admission after elective surgery for cancer, particularly in the short term. However, its predictive capacity with time diminished, suggesting a potential need for longitudinal reassessment to ensure appropriate prognostication in this population.
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Affiliation(s)
- Ryan R Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Ryo Ueno
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
| | - Muhammad Alamgeer
- Department of Medicine/School of Clinical Sciences, Monash University, Clayton, VIC, Australia; Department of Medical Oncology, Monash Health, Clayton, VIC, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Krishnaswamy Sundararajan
- Department of Intensive Care, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Raghav Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore; Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; Singapore Gastric Cancer Consortium, Singapore
| | - Michael Bailey
- Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
| | - David Pilcher
- Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia; Department of Intensive Care, Peninsula Health, Frankston, VIC, Australia; Department of Intensive Care, Dandenong Hospital, Dandenong, VIC, Australia; Peninsula Clinical School, Monash University, Frankston, VIC, Australia.
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28
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Jentzsch T, Sundararajan K, Rampersaud YR. The clinical course of symptoms during wait time for lumbar spinal stenosis surgery and its effect on postoperative outcome: a retrospective cohort study. Spine J 2024; 24:644-649. [PMID: 38008188 DOI: 10.1016/j.spinee.2023.11.006] [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] [Received: 08/13/2023] [Revised: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND CONTEXT Wait time for surgeries can be lengthy and its effect on postoperative outcome remains largely unknown. PURPOSE We evaluated the effect of wait time on postoperative outcome and on clinical course while awaiting surgery for lumbar spinal stenosis. STUDY DESIGN/SETTING This was a retrospective cohort study. PATIENT SAMPLE A convenience sample (n=134) from prospective longitudinal studies that provided preoperative Oswestry Disability Index (ODI) data at two different time points and follow-up of ≥12 months. METHODS Wait time was the period between the initial consultation and immediately preoperatively. OUTCOME MEASURES The primary outcome was the ODI minimal clinically important difference (MCID) (<30% vs ≥30% improvement) at 1 year. RESULTS The median wait time was 5.9 (interquartile range (IQR) 8.2) months and postoperative follow-up was 19.2 (IQR 8.1) months. Wait time was not associated with absolute postoperative change in ODI scores, but patients with wait times <12 months were significantly more likely to reach the ODI MCID at last follow-up (66 (73.3%) for <12 months versus 13 (46.4%) for ≥12 months, p=.008; odds ratio=0.29 (95% confidence interval 0.12-0.75), p=.011). During wait time, there was no difference in patients deteriorating above the MCID for each time point (10 [9.7%] versus 5 [16.1%], p=.320). CONCLUSIONS Longer wait times did not negatively influence postoperative outcome in patients with lumbar spinal stenosis using absolute values, but may impact individual patients' ability to achieve MCID. Patient-reported pain-related disability from the initial surgical consultation to surgery is relatively stable in most patients for at least 6 to 12 months.
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Affiliation(s)
- Thorsten Jentzsch
- Schroeder Arthritis Institute & Krembil Research Institute, Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, 399 Bathurst St., 1E-441, Toronto, Ontario M5T 2S8, Canada; Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich 8008 , Switzerland
| | - Kala Sundararajan
- Schroeder Arthritis Institute & Krembil Research Institute, University Health Network. 399 Bathurst St., 1E-441, Toronto, Ontario M5T 2S8, Canada
| | - Yoga Raja Rampersaud
- Schroeder Arthritis Institute & Krembil Research Institute, Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network and Department of Surgery, University of Toronto, 399 Bathurst St., 1E-441, Toronto, Ontario M5T 2S8, Canada; Schroeder Arthritis Institute & Krembil Research Institute, University Health Network. 399 Bathurst St., 1E-441, Toronto, Ontario M5T 2S8, Canada.
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Jiang W, Brown KGM, Koh C, Karunaratne S, Solomon M, Beckenkamp PR, Cole R, Steffens D. Outcome Heterogeneity in Prehabilitation Trials-Are We Comparing Apples and Oranges? J Surg Res 2024; 296:366-375. [PMID: 38306943 DOI: 10.1016/j.jss.2023.12.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/11/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Over the last decade, the number of prehabilitation randomised controlled trials (RCTs) has increased significantly. Therefore, this review aimed to describe the outcomes reported in prehabilitation RCTs in patients undergoing cancer surgery. METHODS A search was conducted in Embase, Allied and Complementary Medicine Database, The Cochrane Library, PsycINFO, MEDLINE, and Cumulated Index to Nursing and Allied Health Literature from inception to July 2021. We included RCTs evaluating the effectiveness of preoperative exercise, nutrition, and psychological interventions on postoperative complications and length of hospital stay in adult oncology patients who underwent thoracic and gastrointestinal cancer surgery. The verbatim outcomes reported in each article were extracted, and each outcome was assessed to determine whether it was defined and measured using a validated tool. Verbatim outcomes were grouped into standardized outcomes and categorized into domains. The quality of outcome reporting in each identified article was assessed using the Harman tool (score range 0-6, where 0 indicated the poorest quality). RESULTS A total of 74 RCTs were included, from which 601 verbatim outcomes were extracted. Only 110 (18.3%) of the verbatim outcomes were defined and 270 (44.9%) were labeled as either "primary" or "secondary" outcomes. Verbatim outcomes were categorized into 119 standardized outcomes and assigned into one of five domains (patient-reported outcomes, surgical outcomes, physical/functional outcomes, disease activity, and intervention delivery). Surgical outcomes were the most common outcomes reported (n = 71 trials, 95.9%). The overall quality of the reported outcomes was poor across trials (median score: 2.0 [IQR = 0.00-3.75]). CONCLUSIONS Prehabilitation RCTs display considerable heterogeneity in outcome reporting, and low outcome reporting quality. The development of standardized core outcome sets may help improve article quality and enhance the clinical utility of prehabilitation following cancer surgery.
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Affiliation(s)
- Wilson Jiang
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia
| | - Kilian G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Department of Colorectal Surgery, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, Discipline of Physiotherapy, The University of Sydney, Camperdown, NSW, Australia
| | - Ruby Cole
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Camperdown, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Institute of Academic Surgery (IAS), Camperdown, NSW, Australia.
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Dunworth S, Barbeito A, Nagavelli H, Higgins D, Edward S, Williams M, Pyati S. Transitional Pain Service: Optimizing Complex Surgical Patients. Curr Pain Headache Rep 2024; 28:141-147. [PMID: 38117461 DOI: 10.1007/s11916-023-01204-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW The care of patients with complex postsurgical pain can be challenging and burdensome for the healthcare system. Transitional pain service (TPS) is a relatively new concept and has not been widely adopted in the USA. This article explores the benefits and barriers of transitional pain services and describes the development of a TPS at our institution. RECENT FINDINGS Evidence from a few institutions that have adopted TPS has shown decreased postsurgical opioid consumption for patients on chronic opioids and decreased incidence of chronic postsurgical opioid use for opioid-naïve patients. The development of a transitional pain service may improve outcomes for these complex patients by providing longitudinal and multidisciplinary perioperative pain care. In this article, we describe the implementation of a TPS at a tertiary medical center. Our TPS model involves a multidisciplinary team of anesthesiologists, pain psychologists, surgeons, and advanced practice providers. We provide longitudinal care, including preoperative education and optimization; perioperative multimodal analgesic care; and longitudinal follow-up for 90 days post-procedure. With our TPS service, we aim to reduce long-term opioid use and improve functional outcomes for our patients.
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Affiliation(s)
- Sophia Dunworth
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Atilio Barbeito
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Harika Nagavelli
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Diana Higgins
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Shibu Edward
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Melvania Williams
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Srinivas Pyati
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA.
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA.
- Present address: Department of Anesthesiology, Duke University School of Medicine, Durham Veterans Affairs Healthcare System, PO Box 3094, Durham, NC, 27701, USA.
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Ferrero A, Massobrio R, Villa M, Badellino E, Sanjinez JOSP, Giorgi M, Testi A, Govone F, Attianese D, Biglia N. Development and clinical application of a tool to identify frailty in elderly patients with gynecological cancers. Int J Gynecol Cancer 2024; 34:300-306. [PMID: 37487663 DOI: 10.1136/ijgc-2023-004306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE Frailty is more reliable than chronological age in predicting the effectiveness and tolerability of treatments in cancer patients. An increasing number of screening tools have been proposed, however none have received unanimous consent or been specifically designed for women with gynecological malignancies.This study's aim was to develop a clinical application of a screening tool to identify frail patients >70 years old diagnosed with either ovarian or endometrial cancers. METHODS A 20 item questionnaire was developed and administered to the cohort before surgery or neoadjuvant chemotherapy. A cut-off for frailty definition was determined by analyzing the correlation of questionnaire scores with the completion of treatments. The association between frailty and treatment related complications was assessed using a Chi-squared test for categorical variables and a t-test for continuous variables. RESULTS Our study included 100 patients, 50% diagnosed with endometrial cancer and 50% with ovarian cancer. A questionnaire score of 4 was the best cut-off for frailty definition (sensitivity 77%, specificity 100%). Surgical grade III and grade IV complications were observed only in frail patients (p=0.01) and hospitalization was significantly longer in frail women affected by ovarian cancer (p=0.01). Frail patients were more exposed to chemotherapy administration delay (p=0.0005), treatment discontinuation (p=0.001) and hematological toxicities, especially anemia ≥grade 2 (p=0.009) and thrombocytopenia any grade (p=0.0001). CONCLUSION With a cut-off score of 4, our tool can identify frail patients with significantly higher incidence of grade III-IV postoperative complications, length of stay, medical treatment discontinuation rates and hematological toxicities.
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Affiliation(s)
- Annamaria Ferrero
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Roberta Massobrio
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Michela Villa
- Division of Gynecology and Obstetrics, Ospedale Cardinal Massaia di Asti, Asti, Piemonte, Italy
| | - Enrico Badellino
- Division of Gynecology and Obstetrics, Ospedale Cardinal Massaia di Asti, Asti, Piemonte, Italy
| | - Jeremy Oscar Smith Pezua Sanjinez
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Margherita Giorgi
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Alessandra Testi
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Francesca Govone
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Daniela Attianese
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Nicoletta Biglia
- Academic Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
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Griffin SB, Palmer MA, Strodl E, Lai R, Guo C, Chuah TL, Burstow MJ, Ross LJ. Impact of a dietitian-led very low calorie diet clinic on perioperative risk for patients with obesity awaiting elective, non-bariatric surgery: A retrospective cohort study. Surgery 2024; 175:463-470. [PMID: 37953146 DOI: 10.1016/j.surg.2023.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Despite a lack of evidence that intentional weight loss reduces the risk of postoperative complications, adults with obesity are commonly asked to lose weight before elective surgery. We hypothesized that patients undertaking dietitian-led preoperative, very low calorie diet treatment could reduce perioperative surgery risks, as per validated risk scoring systems. The purpose of this study was to measure the impact of a dietitian-led preoperative very low calorie diet clinic on the American Society of Anesthesiologists physical status scores and National Surgical Quality Improvement Program Surgical Risk Calculator scores for patients with obesity awaiting non-bariatric elective surgery. METHODS This retrospective cohort study included patients referred to the preoperative dietitian-led very low calorie diet clinic before elective surgical procedures over a 2-year-9-month period. The dietitian prescribed individualized, very low calorie diet-based treatment. Primary outcomes were changes in the American Society of Anesthesiologists and Surgical Risk Calculator scores from pretreatment until surgery. RESULTS A total of 141 eligible participants (48 ± 13.4 years, 76% women, body mass index 41.7 ± 6.3 kg/m2) demonstrated clinically significant weight loss (mean 7.1 ± 6.1kg, 5.2% body weight, P < .001). Median treatment duration was 13 weeks (interquartile range 6.2-19.2 weeks). Five participants (3.5%) avoided surgery due to weight loss-related improvements in their condition. American Society of Anesthesiologists scores improved for 16% (n = 22/141) of participants. Overall, the median surgical risk calculator estimated risk of 'serious' and 'any' postoperative complication reduced from 4.8% to 3.9% (P < .001) and 6% to 5.1% (P < .001), respectively. Reduction in all Surgical Risk Calculator scores occurred, including surgical site infection, re-admission, and cardiac events (P < .05). CONCLUSION The dietitian-led preoperative, very low calorie diet clinic improved American Society of Anesthesiologists and Surgical Risk Calculator scores for non-bariatric elective surgery patients with obesity. Randomized controlled trials comparing this approach with a control group are warranted.
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Affiliation(s)
- Sally B Griffin
- Department of Nutrition & Dietetics, Logan Hospital, Queensland, Australia; School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Michelle A Palmer
- Department of Nutrition & Dietetics, Logan Hospital, Queensland, Australia
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rainbow Lai
- Department of Nutrition & Dietetics, Logan Hospital, Queensland, Australia
| | - Cathy Guo
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Teong L Chuah
- Surgical and Critical Care Services, Logan Hospital, Queensland, Australia; Department of Surgery, Mater Hospital, South Brisbane, Queensland, Australia; Mayne Academy of Surgery, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Matthew J Burstow
- Surgical and Critical Care Services, Logan Hospital, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Lynda J Ross
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Spicer MG, Dennis AT. Perioperative Exercise Testing in Pregnant and Non-Pregnant Women of Reproductive Age: A Systematic Review. J Clin Med 2024; 13:416. [PMID: 38256550 PMCID: PMC10816516 DOI: 10.3390/jcm13020416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Women have classically been excluded from the development of normal data and reference ranges, with pregnant women experiencing further neglect. The incidence of Caesarean section in pregnant women, and of general operative management in young women (both pregnant and non-pregnant), necessitates the formal development of healthy baseline data in these cohorts to optimise their perioperative management. This systematic review assesses the representation of young women in existing reference ranges for several functional exercise tests in common use to facilitate functional assessment in this cohort. METHODS Existing reference range data for the exercise tests the Six Minute Walk Test (6MWT), the Incremental Shuttle Walk Test (ISWT) and Cardiopulmonary Exercise Testing (CPET) in young women of reproductive age were assessed using the MEDLINE (Ovid) database, last searched December 2023. Results were comparatively tabulated but not statistically analysed given underlying variances in data. RESULTS The role of exercise testing in the perioperative period as an assessment tool, as well as its safety during pregnancy, was evaluated using 65 studies which met inclusion criteria. CONCLUSION There is a significant lack of baseline data regarding these tests in this population, especially amongst the pregnant cohort, which limits the application of exercise testing clinically.
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Affiliation(s)
- Madeleine G. Spicer
- Department of Obstetrics and Gynaecology, Alice Springs Hospital, Alice Springs, NT 0870, Australia
| | - Alicia T. Dennis
- Department of Anaesthesia, Pain and Perioperative Medicine, Joan Kirner Women’s and Children’s Hospital, Western Health, St Albans, VIC 3021, Australia;
- School of Medicine, Faculty of Health, Deakin University, Melbourne, VIC 3125, Australia
- Departments of Critical Care, Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC 3010, Australia
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Kasvis P, Vigano A, Bui T, Carli F, Kilgour RD. Cancer symptom burden negatively affects health-related quality of life in patients undergoing prehabilitation prior to liver resection: results from a 12-week randomized controlled trial. Appl Physiol Nutr Metab 2024; 49:64-76. [PMID: 37690126 DOI: 10.1139/apnm-2023-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
TAKE HOME MESSAGE Cancer symptoms negatively affect health-related quality of life (HRQoL) in patients with cancer awaiting liver resection. Prehabilitation maintained HRQoL after surgery. Future studies should test whether relieving cancer symptoms can improve HRQoL.
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Affiliation(s)
- Popi Kasvis
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC, Canada
- Supportive and Palliative Care Division, McGill University Health Centre, Montreal, QC, Canada
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC, Canada
- Supportive and Palliative Care Division, McGill University Health Centre, Montreal, QC, Canada
| | - Tram Bui
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Franco Carli
- Department of Anesthesiology, McGill University Health Centre, Montreal, QC, Canada
| | - Robert D Kilgour
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC, Canada
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
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Cachecho S, Fąfara A, Lacombe F, Bussières A, Dahan-Oliel N. Current rehabilitation practice for the evaluation and treatment of children with arthrogryposis: an international survey. Disabil Rehabil 2024; 46:96-104. [PMID: 36582123 DOI: 10.1080/09638288.2022.2161644] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe the current practices in rehabilitation for the evaluation and treatment of children with arthrogryposis multiplex congenita (AMC). MATERIALS AND METHODS Rehabilitation practitioners worldwide with at least 2 years of experience with AMC were invited to complete an electronic survey on the evaluations and treatments used with children with AMC within five areas: muscle and joint function, self-care, mobility, pain, participation and psychosocial wellbeing. RESULTS Sixty five participants from nine countries completed the survey. Participants completed the sections applicable to their practice. Number of participants within each area varied between 24 and 53. Over 80% of participants used non-standardized evaluations across areas while <50% used patient-reported or standardized measures. Stretching of upper and lower limbs was reported by >80% across ages and clinical presentation severity. Strengthening reported by >70% was mainly used among children >3 years old with less severe contractures. Other interventions used across areas included orthotics (>70%), positioning (>80%), activity-based training (>80%), assistive devices for self-care (>50%) and mobility (>80%), and energy conservation (>70%). Over 70% of participants were involved in perioperative rehabilitation. CONCLUSION Knowledge of current pediatric rehabilitation practice in AMC, together with empirical evidence, may guide clinical decision-making and identify avenues for future research.
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Affiliation(s)
| | - Alicja Fąfara
- Institue of Physiotherapy, Jagiellonian University, Krakow, Poland
| | | | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Noemi Dahan-Oliel
- Shriners Hospital for Children, Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Sabajo CR, Ten Cate DWG, Heijmans MHM, Koot CTG, van Leeuwen LVL, Slooter GD. Prehabilitation in colorectal cancer surgery improves outcome and reduces hospital costs. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107302. [PMID: 38043359 DOI: 10.1016/j.ejso.2023.107302] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Increasing evidence suggests that multimodal prehabilitation programs reduce postoperative complication rates and length of stay. Nevertheless, prehabilitation is not standard care yet, also as financial consequences of such programs are lacking. Aim of this study was to analyse clinical outcomes and effects on hospital resources if prehabilitation is implemented for patients who are planned for colorectal surgery. MATERIALS AND METHODS Patients undergoing elective colorectal surgery and who received either prehabilitation or standard care between January 2017 and March 2022 in a regional Dutch hospital were included. Outcome parameters were length of hospital stay, 30-day postoperative complications, 30-day ICU admission, readmission rates and hospital costs. RESULTS A total of 196 patients completed prehabilitation whereas 390 patients received standard care. Lower overall complication rates (31 % vs 40 %, p = 0.04) and severe complication rates (20 % vs 31 %, p = 0.01) were observed in the prehabilitation group compared to standard care. Length of stay was shorter in the prehabilitation group (mean 5.80 days vs 6.71 days). In hospital cost savings were €1109 per patient, while the calculated investment for prehabilitation was €969. CONCLUSION Implementation of a multimodal prehabilitation program in colorectal surgery reduces postoperative complication rates, length of stay and hospital costs.
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Affiliation(s)
- Charissa R Sabajo
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands; Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - David W G Ten Cate
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Margot H M Heijmans
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Christian T G Koot
- Department of Finance and Control, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Lisanne V L van Leeuwen
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
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Anthuber L, Sommer F, Wolf S, Vlasenko D, Hoffmann M, Arndt TT, Schiele S, Anthuber M, Schrempf MC. Influence of perioperative step volume on complication rate and length of hospital stay after colorectal cancer surgery (IPOS trial): study protocol for a randomised controlled single-centre trial at a German university hospital. BMJ Open 2023; 13:e076298. [PMID: 38114280 DOI: 10.1136/bmjopen-2023-076298] [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] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Perioperative mobilisation and physical activity are critical components of postoperative rehabilitation. Physical inactivity is a significant risk factor for complications and prolonged hospitalisation. However, specific recommendations for preoperative and postoperative physical activity levels are currently lacking. Evidence suggests that daily step count before and after surgery may impact the length of hospital stay and complication rate.The goal of this study is to determine the effectiveness of perioperative step volume recommendations, measured by pedometers, in reducing the length of hospital stay and complication rate for patients undergoing colorectal cancer surgery. METHODS This study is a single-centre randomised controlled trial with two arms, allocated at a 1:1 ratio. The trial includes individuals undergoing colorectal surgery for either suspected or confirmed colorectal malignancy. A total of 222 patients will be randomly assigned to either an intervention or a control group. Step counts will be measured using a pedometer. Patients assigned to the intervention group will be given a predetermined preoperative and postoperative step count goal. The analysis will be conducted on preoperative and postoperative physical activity, quality of life, health, duration of hospitalisation, complication rate and bowel function, among other factors. ETHICS AND DISSEMINATION The trial was approved by the ethics committee of the Ludwig-Maximilians-University of Munich, Germany (reference number: 22-0758, protocol version 2022.02). Results will be published in peer-reviewed journals and shared at academic conferences. After the publication of the results, a fully anonymised data set and the statistical code can be made available on justified scientific request and after ethical approval has been granted. TRIAL REGISTRATION NUMBER DRKS00030017.
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Affiliation(s)
- Lena Anthuber
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Sebastian Wolf
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Dmytro Vlasenko
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Michael Hoffmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Tim Tobias Arndt
- Department of Computational Statistics and Data Analysis, University of Augsburg, Augsburg, Germany
| | - Stefan Schiele
- Department of Computational Statistics and Data Analysis, University of Augsburg, Augsburg, Germany
| | - Matthias Anthuber
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Christian Schrempf
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
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Dijkstra S, Hartog J, Fleer J, van der Harst P, van der Woude LHV, Mariani MA. Feasibility of preoperative and postoperative physical rehabilitation for cardiac surgery patients - a longitudinal cohort study. BMC Sports Sci Med Rehabil 2023; 15:173. [PMID: 38115103 PMCID: PMC10731823 DOI: 10.1186/s13102-023-00786-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND This study aimed to determine the feasibility of a preoperative and postoperative (in- and outpatient) physical rehabilitation program, the Heart-ROCQ-pilot program. METHODS This cohort study included patients undergoing cardiac surgery (including coronary artery bypass graft surgery, valve surgery, aortic surgery, or combinations of these surgeries) and participated in the Heart-ROCQ-pilot program. Feasibility involved compliance and characteristics of bicycle and strength training sessions in the three rehabilitation phases. RESULTS Of the eligible patients, 56% (n = 74) participated in the program (41% of exclusions were due to various health reasons). On average across the rehabilitation phases, the compliance rates of bicycle and strength training were 88% and 83%, respectively. Workload to heart rate (W/HR) ratio and total absolute volume load for bicycle and strength training, respectively, improved in each rehabilitation phase (P < 0.05). The W/HR-ratio was higher during the last postoperative session compared to the first preoperative session (0.48 to 0.63 W/beat, P < 0.001) and similar to the last preoperative session (0.65 to 0.64 W/beat, P < 0.497). During less than 1% of the bicycle sessions, patients reported discomfort scores of 5 to 6 (scale 0-10, with higher scores indicating a higher level). CONCLUSIONS The Heart-ROCQ-pilot program was feasible for patients awaiting cardiac surgery. Patients were very compliant and were able to safely increase the training load before surgery and regained this improvement within eight weeks after surgery.
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Affiliation(s)
- Sandra Dijkstra
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Johanneke Hartog
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Zarate Rodriguez JG, Cos H, Srivastava R, Bewley A, Raper L, Li D, Dai R, Williams GA, Fields RC, Hawkins WG, Lu C, Sanford DE, Hammill CW. Preoperative levels of physical activity can be increased in pancreatectomy patients via a remotely monitored, telephone-based intervention: A randomized trial. SURGERY IN PRACTICE AND SCIENCE 2023; 15:100212. [PMID: 39844811 PMCID: PMC11749940 DOI: 10.1016/j.sipas.2023.100212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2025] Open
Abstract
Background Higher levels of preoperative physical activity are associated with improved outcomes after pancreatectomy, but it remains unclear if preoperative activity levels are modifiable. Methods Patients undergoing pancreatectomy were randomized 1:1 to a telephone-based intervention at least one week before surgery or to control. All patients wore wearable devices to remotely collect physical activity and clinical data. Results In total, 152 patients were enrolled and 83 completed the study (41 intervention and 42 control). The intervention group walked 4568 (SD 2522) average daily steps pre-intervention, which increased to 5071 (SD 3055) post-intervention (p = 0.042) (11.0% increase). The control group walked 5260 (SD 2795) average daily steps. There were no differences in the rate of severe complications between groups (intervention 22.9% vs control 20.5%, p = 0.807). Conclusions A telephone-based intervention increased average daily step count in patients scheduled to undergo pancreatectomy, demonstrating physical activity is a modifiable target for surgical prehabilitation protocols.
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Affiliation(s)
- Jorge G. Zarate Rodriguez
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Heidy Cos
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Rohit Srivastava
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Alice Bewley
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Lacey Raper
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Dingwen Li
- Department of Computer Science and Engineering, McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Ruixuan Dai
- Department of Computer Science and Engineering, McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Gregory A. Williams
- Department of Radiology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan C. Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - William G. Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Chenyang Lu
- Department of Computer Science and Engineering, McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Dominic E. Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Chet W. Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
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Blumenau Pedersen M, Saxton J, Birch S, Rasmussen Villumsen B, Bjerggaard Jensen J. The use of digital technologies to support home-based prehabilitation prior to major surgery: A systematic review. Surgeon 2023; 21:e305-e315. [PMID: 37336649 DOI: 10.1016/j.surge.2023.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Prehabilitation is a multidimensional and multidisciplinary approach, to prepare patients for surgery, with the aim of improving postoperative outcomes. Worldwide, healthcare systems are facing challenges with a gap between demand and supply of healthcare services. Telehealth is seen as a solution for delivering sustainable and efficient treatments. The effect of providing prehabilitation using telehealth solutions is unclear. OBJECTIVE This systematic review investigated the existing literature regarding the effects and feasibility of technologies for remotely supporting home-based prehabilitation compared to standard care on pre- and postoperative outcomes in adults undergoing elective major surgery. METHODS A literature search identified relevant studies published between 1 January 2012 and December 2022 in PubMed, PsychInfo, Cinahl and the Cochrane Library. We included RCTs, feasibility and pilot studies. The quality of studies was evaluated using Cochrane's Risk of bias assessment and by narratively rating the certainty of evidence. RESULTS Six randomized controlled trials and 20 pilot/feasibility studies were included. The number and content of the interventions varied, depending on context and resources. Multiple approaches in the use of digital healthcare solutions were applied and the results highlight the potential of providing health services remotely. CONCLUSION The use of technologies to support remote home-based prehabilitation in patients undergoing elective major surgery is feasible and has high acceptability, though telehealth is a broad term and wide-ranging strategies are used. Digital technologies for supporting home-based prehabilitation are likely to play an essential role in future health care as resources are scarce and innovative solutions are needed.
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Affiliation(s)
- Malene Blumenau Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Urology, Gødstrup Hospital, Gødstrup, Denmark; Department of Occupational- and Physiotherapy, Gødstrup Hospital, Gødstrup, Denmark.
| | - John Saxton
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, UK
| | - Sara Birch
- Department of Occupational- and Physiotherapy, Gødstrup Hospital, Gødstrup, Denmark; University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Gødstrup, Denmark
| | | | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Urology, Gødstrup Hospital, Gødstrup, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Shahrestani S, Brown NJ, Yue JK, Tan LA. Developing Mixed-effects Models to Optimize Prediction of Postoperative Outcomes in a Modern Sample of Over 450,000 Patients Undergoing Elective Cervical Spine Fusion Surgery. Clin Spine Surg 2023; 36:E536-E544. [PMID: 37651572 DOI: 10.1097/bsd.0000000000001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN A retrospective cohort. OBJECTIVE We utilize big data and modeling techniques to create optimized comorbidity indices for predicting postoperative outcomes following cervical spine fusion surgery. SUMMARY OF BACKGROUND DATA Cervical spine decompression and fusion surgery are commonly used to treat degenerative cervical spine pathologies. However, there is a paucity of high-quality data defining the optimal comorbidity indices specifically in patients undergoing cervical spine fusion surgery. METHODS Using data from 2016 to 2019, we queried the Nationwide Readmissions Database (NRD) to identify individuals who had received cervical spine fusion surgery. The Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining indicator was used to assess frailty. To measure the level of comorbidity, Elixhauser Comorbidity Index (ECI) scores were queried. Receiver operating characteristic curves were developed utilizing comorbidity indices as predictor variables for pertinent complications such as mortality, nonroutine discharge, top-quartile cost, top-quartile length of stay, and 1-year readmission. RESULTS A total of 453,717 patients were eligible. Nonroutine discharges occurred in 93,961 (20.7%) patients. The mean adjusted all-payer cost for the procedure was $22,573.14±18,274.86 (top quartile: $26,775.80) and the mean length of stay was 2.7±4.4 days (top quartile: 4.7 d). There were 703 (0.15%) mortalities and 58,254 (12.8%) readmissions within 1 year postoperatively. Models using frailty+ECI as primary predictors consistently outperformed the ECI-only model with statistically significant P -values for most of the complications assessed. Cost and mortality were the only outcomes for which this was not the case, as frailty outperformed both ECI and frailty+ECI in cost ( P <0.0001 for all) and frailty+ECI performed as well as ECI alone in mortality ( P =0.10). CONCLUSIONS Our data suggest that frailty+ECI may most accurately predict clinical outcomes in patients receiving cervical spine fusion surgery. These models may be used to identify high-risk populations and patients who may necessitate greater resource utilization following elective cervical spinal fusion.
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Affiliation(s)
- Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles
- Department of Medical Engineering, California Institute of Technology, Pasadena
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, Orange
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Lee A Tan
- Department of Neurological Surgery, University of California, San Francisco, CA
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Ke Y, Ng RRG, Elangovan S, Leong YH, Goh ZH, Graves N, Shannon NB, Abdullah HR. Prehabilitation programs - a systematic review of the economic evidence. Front Med (Lausanne) 2023; 10:1281843. [PMID: 38105890 PMCID: PMC10722222 DOI: 10.3389/fmed.2023.1281843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Prehabilitation, which involves improving a patient's physical and psychological condition before surgery, has shown potential benefits but has yet to be extensively studied from an economic perspective. To address this gap, a systematic review was conducted to summarize existing economic evaluations of prehabilitation interventions. Methods The PRISMA Protocols 2015 checklist was followed. Over 16,000 manuscripts were reviewed, and 99 reports on preoperative interventions and screening tests were identified, of which 12 studies were included in this analysis. The costs are expressed in Pounds (GBP, £) and adjusted for inflation to December 2022. Results The studies were conducted in Western countries, focusing on specific surgical subspecialties. While the interventions and study designs varied, most studies demonstrated cost savings in the intervention group compared to the control group. Additionally, all cost-effectiveness analysis studies favored the intervention group. However, the review also identified several limitations. Many studies had a moderate or high risk of bias, and critical information such as time horizons and discount rates were often missing. Important components like heterogeneity, distributional effects, and uncertainty were frequently lacking as well. The misclassification of economic evaluation types highlighted a lack of knowledge among physicians in prehabilitation research. Conclusion This review reveals a lack of robust evidence regarding the economics of prehabilitation programs for surgical patients. This suggests a need for further research with rigorous methods and accurate definitions.
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Affiliation(s)
- Yuhe Ke
- Department of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Roderica Rui Ge Ng
- Department of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Shalini Elangovan
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yun Hao Leong
- Department of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Zhao Han Goh
- Department of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nicholas Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Nicholas B. Shannon
- Duke-NUS Medical School, Singapore, Singapore
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hairil Rizal Abdullah
- Department of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Kshirsagar RS, Eide JG, Qatanani A, Harris J, Birkenbeuel JL, Wang BY, Kuan EC, Palmer JN, Adappa ND. Frailty does not worsen postoperative outcomes in sinonasal squamous cell carcinoma. Am J Otolaryngol 2023; 44:103972. [PMID: 37459744 DOI: 10.1016/j.amjoto.2023.103972] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE Sinonasal squamous cell carcinoma (SCC) is an aggressive malignancy frequently requiring surgical resection and adjuvant treatment. Frailty is a metric that attempts to estimate a patient's ability to tolerate the physiologic stress of treatment. There is limited work describing frailty in patients with sinonasal cancer. We sought to determine the impact of frailty on postoperative outcomes in patients undergoing treatment for sinonasal SCC. MATERIALS AND METHODS Cases of patients undergoing surgical resection of sinonasal SCC at two tertiary medical centers were queried. Demographic, treatment, and survival data were recorded. Frailty was calculated using validated indexes, including the American Society of Anesthesiologists (ASA) classification, modified 5-item frailty index (mFI-5), and the Charlson Comorbidity Index (CCI). Primary outcomes included medical and surgical complications, readmission, and length of stay (LOS). RESULTS 38 patients were included. There were 23 (60.5 %) men and 15 (39.5 %) women with an average age of 59.6 ± 12.1 years. MFI-5 was 0.76 ± 0.54 and CCI was 5.71 ± 2.64. No significant association was noted between frailty measures and postoperative outcomes including 30-day medical complications, 30-day surgical complications, any 30-day complication, and readmission. Increased ASA was noted to be predictive of increased length of stay (Incidence Rate Ratio: 1.80, 95 % confidence interval [CI]: 1.16-2.83, p = 0.009). CONCLUSIONS We found no association between frailty metrics and worsening surgical or medical postoperative outcomes. This suggests that frailty metrics may not be as relevant for sinonasal surgery even for advanced pathologies, given the more limited physiologic impact of minimally invasive surgery.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Redwood City Medical Center, Redwood City, CA, United States of America
| | - Jacob G Eide
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, United States of America
| | - Anas Qatanani
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, United States of America
| | - Jacob Harris
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, United States of America
| | - Beverly Y Wang
- Department of Pathology, University of California Irvine, Orange, CA, United States of America
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, United States of America
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America.
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Kovoor JG, Nann SD, Barot DD, Garg D, Hains L, Stretton B, Ovenden CD, Bacchi S, Chan E, Gupta AK, Hugh TJ. Prehabilitation for general surgery: a systematic review of randomized controlled trials. ANZ J Surg 2023; 93:2411-2425. [PMID: 37675939 DOI: 10.1111/ans.18684] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/23/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline-level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery. METHODS This study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta-analysis was precluded due to heterogeneity across included studies. RESULTS From 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%). CONCLUSIONS Prehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system-level delivery across General Surgery within standardized protocols. However, given potential benefits and non-inferiority to standard care, they should be considered on a case-by-case basis.
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Affiliation(s)
- Joshua G Kovoor
- University of Sydney, Sydney, New South Wales, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Silas D Nann
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Dwarkesh D Barot
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Devanshu Garg
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Lewis Hains
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Erick Chan
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Aashray K Gupta
- University of Sydney, Sydney, New South Wales, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
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Kjeldsted E, Ammitzbøll G, Jørgensen LB, Lodin A, Bojesen RD, Ceballos SG, Rosthøj S, Lænkholm AV, Skou ST, Jack S, Gehl J, Dalton SO. Neo-train: study protocol and feasibility results for a two-arm randomized controlled trial investigating the effect of supervised exercise during neoadjuvant chemotherapy on tumour response in patients with breast cancer. BMC Cancer 2023; 23:777. [PMID: 37598196 PMCID: PMC10439618 DOI: 10.1186/s12885-023-11284-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Prehabilitation with exercise interventions during neoadjuvant chemotherapy (NACT) is effective in reducing physical and psychosocial chemotherapy-related adverse events in patients with cancer. In preclinical studies, data also support a growth inhibitory effect of aerobic exercise on the tumour microenvironment with possible improved chemotherapy delivery but evidence in human patients is limited. The aim of the study here described is to investigate if supervised exercise with high-intensity aerobic and resistance training during NACT can improve tumour reduction in patients with breast cancer. METHODS This parallel two-armed randomized controlled trial is planned to include 120 women aged ≥ 18 years with newly diagnosed breast cancer starting standard NACT at a university hospital in Denmark (a total of 90 participants needed according to the power calculation and allowing 25% (n = 30) dropout). The participants will be randomized to usual care or supervised exercise consisting of high-intensity interval training on a stationary exercise bike and machine-based progressive resistance training offered three times a week for 24 weeks during NACT, and screening-based advice to seek counselling in case of moderate-severe psychological distress (Neo-Train program). The primary outcome is tumour size change (maximum diameter of the largest lesion in millimetre) measured by magnetic resonance imaging prior to surgery. Secondary outcomes include clinical/pathological, physical and patient-reported measures such as relative dose intensity of NACT, hospital admissions, body composition, physical fitness, muscle strength, health-related quality of life, general anxiety, depression, and biological measures such as intratumoural vascularity, tumour infiltrating lymphocytes, circulating tumour DNA and blood chemistry. Outcomes will be measured at baseline (one week before to 1-2 weeks after starting NACT), during NACT (approximately week 7, 13 and 19), pre-surgery (approximately week 21-29), at surgery (approximately week 21-30) and 3 months post-surgery (approximately 33-42 weeks from baseline). DISCUSSION This study will provide novel and important data on the potential benefits of supervised aerobic and resistance exercise concomitant to NACT on tumour response and the tumour microenvironment in patients with breast cancer, with potential importance for survival and risk of recurrence. If effective, our study may help increase focus of exercise as an active part of the neoadjuvant treatment strategy. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov (NCT04623554) on November 10, 2020.
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Affiliation(s)
- Eva Kjeldsted
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark.
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, 2100, Denmark.
- Danish Research Centre for Equality in Cancer (COMPAS), Rådmannsengen 5, Naestved, 4700, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark.
| | - Gunn Ammitzbøll
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, 2100, Denmark
- Danish Research Centre for Equality in Cancer (COMPAS), Rådmannsengen 5, Naestved, 4700, Denmark
| | - Lars Bo Jørgensen
- Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Sygehusvej 10, Roskilde, 4000, Denmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved- Slagelse-Ringsted Hospitals, Faelledvej 2C, 1, Slagelse, 4200, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
| | - Alexey Lodin
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark
| | - Rasmus Dahlin Bojesen
- Department of Surgery, Naestved-Slagelse-Ringsted Hospitals, Faelledvej 11, Slagelse, 4200, Denmark
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, Køge, 4600, Denmark
| | | | - Susanne Rosthøj
- Statistics & Data Analysis, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, 2100, Denmark
| | - Anne-Vibeke Lænkholm
- Department of Pathology, Zealand University Hospital, Sygehusvej 9, Roskilde, 4000, Denmark
| | - Søren T Skou
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved- Slagelse-Ringsted Hospitals, Faelledvej 2C, 1, Slagelse, 4200, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
| | - Sandy Jack
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, MP218, Tremona Road, Southampton, SO16 6YD, UK
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Rådmannsengen 5, Naestved, 4700, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Strandboulevarden 49, Copenhagen, 2100, Denmark
- Danish Research Centre for Equality in Cancer (COMPAS), Rådmannsengen 5, Naestved, 4700, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
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Jin Z, Rismany J, Gidicsin C, Bergese SD. Frailty: the perioperative and anesthesia challenges of an emerging pandemic. J Anesth 2023; 37:624-640. [PMID: 37311899 PMCID: PMC10263381 DOI: 10.1007/s00540-023-03206-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/22/2023] [Indexed: 06/15/2023]
Abstract
Frailty is a complex and multisystem biological process characterized by reductions in physiological reserve. It is an increasingly common phenomena in the surgical population, and significantly impacts postoperative recovery. In this review, we will discuss the pathophysiology of frailty, as well as preoperative, intraoperative, and postoperative considerations for frailty care. We will also discuss the different models of postoperative care, including enhanced recovery pathways, as well as elective critical care admission. With discoveries of new effective interventions, and advances in healthcare information technology, optimized pathways could be developed to provide the best care possible that meets the challenges of perioperative frailty.
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Affiliation(s)
- Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Joshua Rismany
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Christopher Gidicsin
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Level 4, Room 060, Stony Brook, NY, 11794-8480, USA.
- Department of Neurosurgery, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.
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Olsen DB, Pedersen PU, Noergaard MW. Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review. JBI Evid Synth 2023; 21:1190-1242. [PMID: 36929938 DOI: 10.11124/jbies-22-00265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The objective of this scoping review was to identify and map existing preoperative interventions, referred to as prehabilitation, in adult patients at home awaiting elective coronary artery bypass grafting surgery. This review also sought to report feasibility and patient experiences to shape clinical practice and underpin a future systematic review. INTRODUCTION As patients age, comorbidities become more common. Strategies to improve postoperative outcomes and to accelerate recovery are required in patients undergoing coronary artery bypass grafting. Prehabilitation refers to a proactive process of increasing functional capacity before surgery to improve the patient's ability to withstand upcoming physiologic stress and, thus, avoid postoperative complications. INCLUSION CRITERIA Studies that included adult patients waiting for coronary artery bypass grafting surgery at home and that described interventions optimizing preoperative physical and psychological health in any setting were included. METHODS The JBI methodology for conducting scoping reviews was used to identify relevant studies in MEDLINE (PubMed), CINAHL (EBSCOhost), Cochrane Library, Embase (Ovid), Scopus, SweMed+, PsycINFO (EBSCOhost), and PEDro. Gray literature was identified searching Google Scholar, ProQuest Dissertations and Theses, MedNar, OpenGrey, NICE Evidence search, and SIGN. Studies in Danish, English, German, Norwegian, and Swedish were considered for inclusion, with no geographical or cultural limitations, or date restrictions. Two independent reviewers screened titles and abstracts, and studies meeting the inclusion criteria were imported into Covidence. Sixty-seven studies from November 1987 to September 2022 were included. The data extraction tool used for the included papers was developed in accordance with the review questions and tested for adequacy and comprehensiveness with the first 5 studies by the same 2 independent reviewers. The tool was then edited to best reflect the review questions. Extracted findings are described and supported by figures and tables. RESULTS Sixty-seven studies were eligible for inclusion, representing 28,553 participants. Analyses of extracted data identified various preoperative interventions for optimizing postoperative and psychological outcomes for adult patients awaiting elective coronary artery bypass grafting surgery. Based on similarities, interventions were grouped into 5 categories. Eighteen studies reported on multimodal interventions, 17 reported on psychological interventions, 14 on physical training interventions, 13 on education interventions, and 5 on oral health interventions. CONCLUSION This scoping review provides a comprehensive summary of strategies that can be applied when developing a prehabilitation program for patients awaiting elective coronary artery bypass surgery. Although prehabilitation has been tested extensively and appears to be feasible, available evidence is mostly based on small studies. For patients undergoing elective coronary artery bypass grafting to derive benefit from prehabilitation, methodologically robust clinical trials and knowledge synthesis are required to identify optimal strategies for patient selection, intervention design, adherence, and intervention duration. Future research should also consider the cost-effectiveness of prehabilitation interventions before surgery. Finally, there is a need for more qualitative studies examining whether individual interventions are meaningful and appropriate to patients, which is an important factor if interventions are to be effective.
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Affiliation(s)
- Dorte Baek Olsen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Preben U Pedersen
- Danish Centre of Systematic Reviews: A JBI Centre of Exellence, Centre of Clinical Guidelines - Danish National Clearinghouse, Aalborg University, Denmark
| | - Marianne Wetendorff Noergaard
- Danish Centre of Systematic Reviews: A JBI Centre of Exellence, Centre of Clinical Guidelines - Danish National Clearinghouse, Aalborg University, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev 2023; 5:CD013259. [PMID: 37162250 PMCID: PMC10171468 DOI: 10.1002/14651858.cd013259.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Surgery is the cornerstone in curative treatment of colorectal cancer. Unfortunately, surgery itself can adversely affect patient health. 'Enhanced Recovery After Surgery' programmes, which include multimodal interventions, have improved patient outcomes substantially. However, these are mainly applied peri- and postoperatively. Multimodal prehabilitation includes multiple preoperative interventions to prepare patients for surgery with the aim of increasing resilience, thereby improving postoperative outcomes. OBJECTIVES To determine the effects of multimodal prehabilitation programmes on functional capacity, postoperative complications, and quality of life in adult patients undergoing surgery for colorectal cancer. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and PsycINFO in January 2021. We also searched trial registries up to March 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) in adult patients with non-metastatic colorectal cancer, scheduled for surgery, comparing multimodal prehabilitation programmes (defined as comprising at least two preoperative interventions) with no prehabilitation. We focused on the following outcomes: functional capacity (i.e. 6-minute walk test, VO2peak, handgrip strength), postoperative outcomes (i.e. complications, mortality, length of hospital stay, emergency department visits, re-admissions), health-related quality of life, compliance, safety of prehabilitation, and return to normal activities. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data, assessed risk of bias and used GRADE to assess the certainty of the evidence. Any disagreements were solved with discussion and consensus. We pooled data to perform meta-analyses, where possible. MAIN RESULTS We included three RCTs that enrolled 250 participants with non-metastatic colorectal cancer, scheduled for elective (mainly laparoscopic) surgery. Included trials were conducted in tertiary care centres and recruited patients during periods ranging from 17 months to 45 months. A total of 130 participants enrolled in a preoperative four-week trimodal prehabilitation programme consisting of exercise, nutritional intervention, and anxiety reduction techniques. Outcomes of these participants were compared to those of 120 participants who started an identical but postoperative programme. Postoperatively, prehabilitation may improve functional capacity, determined with the 6-minute walk test at four and eight weeks (mean difference (MD) 26.02, 95% confidence interval (CI) -13.81 to 65.85; 2 studies; n = 131; and MD 26.58, 95% CI -8.88 to 62.04; 2 studies; n = 140); however, the certainty of evidence is low and very low, respectively, due to serious risk of bias, imprecision, and inconsistency. After prehabilitation, the functional capacity before surgery improved, with a clinically relevant mean difference of 24.91 metres (95% CI 11.24 to 38.57; 3 studies; n = 225). The certainty of evidence was moderate due to downgrading for serious risk of bias. The effects of prehabilitation on the number of complications (RR 0.95, 95% CI 0.70 to 1.29; 3 studies; n = 250), emergency department visits (RR 0.72, 95% CI 0.39 to 1.32; 3 studies; n = 250) and re-admissions (RR 1.20, 95% CI 0.54 to 2.65; 3 studies; n = 250) were small or even trivial. The certainty of evidence was low due to downgrading for serious risk of bias and imprecision. The effects on VO2peak, handgrip strength, length of hospital stay, mortality rate, health-related quality of life, return to normal activities, safety of the programme, and compliance rate could not be analysed quantitatively due to missing or insufficient data. The included studies did not report a difference between groups for health-related quality of life and length of hospital stay. Data on remaining outcomes were not reported or were reported inadequately in the included studies. AUTHORS' CONCLUSIONS Prehabilitation may result in an improved functional capacity, determined with the 6-minute walk test both preoperatively and postoperatively. A solid effect on the number of omplications, postoperative emergency department visits and re-admissions could not be established. The certainty of evidence ranges from moderate to very low, due to downgrading for serious risk of bias, imprecision and inconsistency. In addition, only three heterogeneous studies were included in this review. Therefore, the findings of this review should be interpreted with caution. Numerous relevant RCTs are ongoing and will be included in a future update of this review.
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Affiliation(s)
| | | | | | - Rudi Mh Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
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Molenaar CJL, Reudink M, Sabajo CR, Janssen L, Roumen RMH, Klaase JM, Slooter GD. Prehabilitation for patients with colorectal cancer: a snapshot of current daily practice in Dutch hospitals. Perioper Med (Lond) 2023; 12:15. [PMID: 37158927 PMCID: PMC10165784 DOI: 10.1186/s13741-023-00299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Multimodal prehabilitation programmes are increasingly being imbedded in colorectal cancer (CRC) pathways to enhance the patient's recovery after surgery. However, there is no (inter)national consensus on the content or design of such a programme. This study aimed to evaluate the current practice and opinion regarding preoperative screening and prehabilitation for patients undergoing surgery for CRC throughout the Netherlands. METHODS All regular Dutch hospitals offering colorectal cancer surgery were included. An online survey was sent to one representative colorectal surgeon per hospital. Descriptive statistics were used for analyses. RESULTS Response rate was 100% (n = 69). Routine preoperative screening of patients with CRC for frailty, diminished nutritional status and anaemia was the standard of care in nearly all Dutch hospitals (97%, 93% and 94%, respectively). Some form of prehabilitation was provided in 46 hospitals (67%) of which more than 80% addressed nutritional status, frailty, physical status and anaemia. All but two of the remaining hospitals were willing to adopt prehabilitation. The majority of the hospitals offered prehabilitation to specific subgroups of patients with CRC, such as the elderly (41%), the frail (71%) or high-risk patients (57%). There was high variability in the setting, design and content of the prehabilitation programmes. CONCLUSIONS Whereas preoperative screening is sufficiently incorporated in Dutch hospitals, standardised enhancement of the patient's condition in the context of multimodal prehabilitation seems to be challenging. This study presents an overview of current clinical practice in the Netherlands. Uniform clinical prehabilitation guidelines are vital to diminish heterogeneity in programmes and to produce useful data to enable a nationwide implementation of an evidence-based prehabilitation programme.
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Affiliation(s)
| | - Muriël Reudink
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands.
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Charissa R Sabajo
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Joost M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
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van Exter SH, Drager LD, van Asseldonk MJMD, Strijker D, van der Schoot ND, van den Heuvel B, Verlaan S, van den Berg MGA. Adherence to and Efficacy of the Nutritional Intervention in Multimodal Prehabilitation in Colorectal and Esophageal Cancer Patients. Nutrients 2023; 15:2133. [PMID: 37432252 PMCID: PMC10181115 DOI: 10.3390/nu15092133] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 07/12/2023] Open
Abstract
Multimodal prehabilitation programs to improve physical fitness before surgery often include nutritional interventions. This study evaluates the efficacy of and adherence to a nutritional intervention among colorectal and esophageal cancer patients undergoing the multimodal Fit4Surgery prehabilitation program. The intervention aims to achieve an intake of ≥1.5 g of protein/kg body weight (BW) per day through dietary advice and daily nutritional supplementation (30 g whey protein). This study shows 56.3% of patients met this goal after prehabilitation. Mean daily protein intake significantly increased from 1.20 ± 0.39 g/kg BW at baseline to 1.61 ± 0.41 g/kg BW after prehabilitation (p < 0.001), with the main increase during the evening snack. BW, BMI, 5-CST, and protein intake at baseline were associated with adherence to the nutritional intervention. These outcomes suggest that dietary counseling and protein supplementation can significantly improve protein intake in different patient groups undergoing a multimodal prehabilitation program.
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Affiliation(s)
- Sabien H. van Exter
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Luuk D. Drager
- Department of Operating Rooms, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Monique J. M. D. van Asseldonk
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Dieuwke Strijker
- Department of Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Nina D. van der Schoot
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Baukje van den Heuvel
- Department of Operating Rooms, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Sjors Verlaan
- Department of Operating Rooms, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- FrieslandCampina, 6708 WH Wageningen, The Netherlands
- Faculty of Sports & Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands
| | - Manon G. A. van den Berg
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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