A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation

Li, Michael H.-G.; Bolshinsky, Vladimir; Ismail, Hilmy; Burbury, Kate; Ho, Kwok M.; Amin, Babak; Heriot, Alexander G.; Riedel, Bernhard

doi:10.1007/s12630-019-01297-9

Cited by 13 publications

(14 citation statements)

References 63 publications

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“…Only one article to date examined the perceptions of both anesthetists and colorectal surgeons to prehabilitation in the colorectal cancer patient population. 10 The results of this research demonstrate clear recognition of the association between functional capacity and postoperative outcomes among both anesthetists and surgeons. This cross-sectional survey concluded that there is a “window of opportunity” for prehabilitation within the colorectal cancer cohort of 2 to 4 weeks after cancer diagnosis and recommended that further multicenter or implementation studies are required.…”

Section: Introductionmentioning

confidence: 64%

“…The results of this study are consistent with those of a recent survey performed with colorectal surgeons and anesthetists, which concluded that surgeons recognize the clear association between functional capacity and postoperative outcomes, robust evidence for prehabilitation is currently lacking and that surgeons would be willing to delay surgery (up to 2 weeks) in order to optimize their patients. 10…”

Section: Discussionmentioning

confidence: 99%

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Attitudes and Perceptions to Prehabilitation in Lung Cancer

et al. 2020

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Background: Prehabilitation to maximize exercise capacity before lung cancer surgery has the potential to improve operative tolerability and patient outcomes. However, translation of this evidence into clinical practice is limited. Aims: To determine the acceptability and perceived benefit of prehabilitation in lung cancer among thoracic surgeons. Procedure: 198 cardiothoracic surgeons within Australia and New Zealand were surveyed to evaluate their attitudes and perceived benefits of prehabilitation in lung cancer. Results: Response rate was 14%. A moderate proportion of respondents reported that there is a need to refer lung resection patients to preoperative physiotherapy/prehabilitation, particularly high-risk patients or those with borderline fitness for surgery. 91% of surgeons were willing to delay surgery (as indicated by cancer stage/type) to optimize patients via prehabilitation. The main barriers to prehabilitation reported were patient comorbidities and access to allied health professionals, with 33% stating that they were unsure who to refer to for prehabilitation in thoracic surgery. This is despite 60% of the cohort reporting that pulmonary rehabilitation is available as a preoperative resource. 92% of respondents believe that further research into prehabilitation in lung cancer is warranted. Conclusion: The benefits of prehabilitation for the oncology population have been well documented in the literature over recent years and this is reflected in the perceptions surgeons had on the benefits of prehabilitation for their patients. This survey demonstrates an interest among cardiothoracic surgeons in favor of prehabilitation, and therefore further research and demonstration of its benefit is needed in lung cancer to facilitate implementation into practice.

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Section: Introductionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Attitudes and Perceptions to Prehabilitation in Lung Cancer

et al. 2020

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“…Despite this growth and the literature containing many reports with experts supporting clinical adoption, there is still a need for more prehabilitation research. 1,[5][6][7][8][9][10][11] Notably, the clinical application of prehabilitation is seemingly outpacing the accumulation of scientific evidence for efficacy due to a combination of factors including that (1) prehabilitation does not typically involve medications or other interventions that are regulated by governmental organizations (e.g., registered clinical trials) and (2) it just makes sense to encourage people to adopt the healthy lifestyle components used in prehabilitation protocols (Fig. 2).…”

Section: Historical and Modern Day Prehabilitationmentioning

confidence: 99%

Prehabilitation May Help Mitigate an Increase in COVID-19 Peripandemic Surgical Morbidity and Mortality

Silver

2020

Am J Phys Med Rehabil

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As physicians specializing in rehabilitation medicine consider sequelae from the novel coronavirus pandemic that began in 2019, one issue that should be top of mind is the physiologic effect that large-scale social distancing had on the health of patients in general but, more specifically, on preoperative patients who had their surgeries delayed or will have newly scheduled procedures during the peripandemic period. Predictably, as the virus becomes less prevalent, there will be a tremendous motivation to move forward with scheduling operations from both patient care and institutional perspectives. However, one can anticipate a pandemic-related increase in surgical morbidity and mortality above prepandemic levels, particularly in older or medically frail patients even if they did not have a novel coronavirus (i.e., COVID-19) infection. Therefore, now is the time to consider for patients awaiting surgery a wider adoption of prehabilitation-physical and psychological assessments that establish a baseline functional level, identify impairments, and provide interventions that promote physical and psychological health to reduce the incidence and/or severity of future impairments.

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“…Results from studies suggest that multimodal prehabilitation has a positive impact on pre-operative physiologic reserve and on postoperative recovery; however, these beneficial effects have not been translated into improvements in postoperative mortality and morbidity, or duration of hospital stay [10][11][12]. Other barriers to the implementation of prehabilitation services are the lack of qualified staff and limited financial resources [13]. As a consequence, the establishment of a complex prehabilitation programme in developing countries remains challenging.…”

Section: Introductionmentioning

confidence: 99%

The effect of trimodal prehabilitation on the physical and psychological health of patients undergoing colorectal surgery: a randomised clinical trial

et al. 2020

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Prehabilitation aims to increase the endurance capacity of patients who are awaiting major surgery. However, there are no studies investigating the implementation of this demanding and expensive intervention in lowincome countries. This study aimed to assess the impact of a 4-week trimodal prehabilitation program on the physical and psychological health of patients waiting for colorectal surgery compared with a control group managed according to enhanced recovery after surgery principles supplemented by nutritional care. This study was a single-centre, randomised controlled trial. The primary outcome measures for the physical aspects were 6-minute walking distance (6MWD) and incentive spirometry, whereas the psychological elements were measured using the 36-item short form survey questionnaire and the hospital anxiety and depression score. In total, data from 149 patients were analysed (77 in the prehabilitation group and 72 in the control group). At the time of surgery, patients in the prehabilitation group had improved 6MWD and incentive spirometry compared with the control group (median (IQR [range]) percentage improvement 131% (112-173 [68-376]) vs. 107% (99-120 [63-163]); p < 0.001 and 113% (100-125 [75-200]) vs. 100% (100-112 [86-167]); p < 0.001 respectively). Patients in the prehabilitation group also had reduced anxiety scores compared with the control group (mean (SD) anxiety score (4 (3) vs. 5 (3) respectively; p = 0.032). However, these effects did not translate into improvements in postoperative mortality and morbidity, or a reduction in duration of hospital stay. Trimodal (physical, emotional and nutritional) prehabilitation is able to improve functional status as well as some parameters of emotional and physical well-being of patients waiting for colorectal surgery.

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A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation

Cited by 13 publications

References 63 publications

Attitudes and Perceptions to Prehabilitation in Lung Cancer

Attitudes and Perceptions to Prehabilitation in Lung Cancer

Prehabilitation May Help Mitigate an Increase in COVID-19 Peripandemic Surgical Morbidity and Mortality

The effect of trimodal prehabilitation on the physical and psychological health of patients undergoing colorectal surgery: a randomised clinical trial

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