Fit4Surgery for cancer patients during covid-19 lockdown – A systematic review and meta-analysis

Gestel, Tess van; Groen, L.C.B.; Puik, Jisce R.; Rooijen, Stefanus J. van; Zaag-Loonen, Hester J. van der; Schoonmade, Linda J.; Danjoux, Gerard; Daams, Freek; Schreurs, W. H.; Bruns, Emma R J

doi:10.1016/j.ejso.2022.02.010

Cited by 10 publications

(5 citation statements)

References 55 publications

(148 reference statements)

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“…29,30 This may even help optimize the outcomes of their surgery, which has been observed in surgical cancer patients and can be undertaken remotely. 31 MI, diabetes, and CTD were shown to be associated with approximately double the mortality risk during the first eight years following THA or KA, which is consistent with previous studies. 32,33 Two systematic reviews by Berstock et al 32,33 assessed mortality up to 90 days following THA or KA, and demonstrated a similar hazard ratio for mortality associated with comorbidities of diabetes and cardiovascular disease.…”

Section: Discussionsupporting

confidence: 91%

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Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty

et al. 2022

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Aims The primary aim was to assess whether preoperative health-related quality of life (HRQoL) was associated with postoperative mortality following total hip arthroplasty (THA) and knee arthroplasty (KA). Secondary aims were to assess whether patient demographics/comorbidities and/or joint-specific function were associated with postoperative mortality. Methods Patients undergoing THA (n = 717) and KA (n = 742) during a one-year period were identified retrospectively from an arthroplasty register. Patient demographics, comorbidities, Oxford score, and EuroQol five-dimension (EQ-5D) were recorded preoperatively. Patients were followed up for a minimum of seven years and their mortality status was obtained. Cox regression analysis was used to adjust for confounding. Results During the study period, 111 patients (15.5%) undergoing THA and 135 patients (18.2%) undergoing KA had died at a mean follow-up of 7.5 years (7 to 8). When adjusting for confounding, the preoperative EQ-5D was associated with postoperative mortality, and for each 0.1 difference in the utility there was an associated change in mortality risk of 6.7% (p = 0.048) after THA, and 6.8% (p = 0.047) after KA. Comorbidities of connective tissue disease (p ≤ 0.026) and diabetes (p ≤ 0.028) were associated with mortality after THA, whereas MI (p ≤ 0.041), diabetes (p ≤ 0.009), and pain in other joints (p ≤ 0.050) were associated with mortality following KA. The preoperative Oxford score was associated with mortality, and for each one-point change in the score there was an associated change in mortality risk of 2.7% (p = 0.025) after THA and 4.3% (p = 0.003) after KA. Conclusion Worse preoperative HRQoL and joint specific function were associated with an increased risk of postoperative mortality. Both HRQoL and joint-specific function decline with longer waiting times to surgery for THA and KA and therefore may result in an increased postoperative mortality risk than would have been expected if surgery had been undertaken earlier. Cite this article: Bone Jt Open 2022;3(12):933–940.

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Section: Discussionsupporting

confidence: 91%

“… 29 , 30 This may even help optimize the outcomes of their surgery, which has been observed in surgical cancer patients and can be undertaken remotely. 31 …”

Section: Discussionmentioning

confidence: 99%

Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty

et al. 2022

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“…This will improvetheiroutcome,ashasbeenseeninpatientswithcancer whoareawaitingsurgery,andcanbeundertakenremotely. 45 This study has limitations. Comorbidities, joint-specific PROMs, and the progression of the radiological appearances were not assessed.…”

Section: Discussionmentioning

confidence: 92%

“…This will improve their outcome, as has been seen in patients with cancer who are awaiting surgery, and can be undertaken remotely. 45…”

Section: Discussionmentioning

confidence: 99%

Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty

Clement

Wickramasinghe

Bayram

et al. 2022

The Bone & Joint Journal

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Aims The primary aim of this study was to assess whether patients waiting six months or more for a total hip (THA) or knee (KA) arthroplasty had a deterioration in their health-related quality of life (HRQoL). Secondary aims were to assess changes in frailty and the number of patients living in a state considered to be worse than death (WTD), and factors associated with changes in HRQoL and frailty. Methods This cross-sectional study included 326 patients, 150 males (46.0%) and 176 females (54.0%), with a mean age of 68.6 years (SD 9.8) who were randomly selected from waiting lists at four centres and had been waiting for six months or more (median 13 months, interquartile range 10 to 21) for a primary THA (n = 161) or KA (n = 165). The EuroQol five-dimension questionnaire (EQ-5D) and visual analogue scores (EQ-VAS), Rockwood Clinical Frailty Scale (CFS), and 36-Item Short Form Survey subjective change in HRQoL were assessed at the time and recalled for six months earlier. A state that was WTD was defined as an EQ-5D of less than zero. Results There were significant deteriorations in the EQ-5D (mean 0.175, 95% confidence interval (CI) 0.145 to 0.204; p < 0.001), EQ-VAS (mean 8.6, 95% CI 7.0 to 10.4; < 0.001), and CFS (from 3 “managing well” to 4 “vulnerable”; p < 0.001), and a significant increase in the number of those in a state that was WTD (n = 48; p < 0.001) during the previous six months for the whole cohort. A total of 110 patients (33.7%) stated that their health was much worse and 107 (32.8%) felt it was somewhat worse compared with six months previously. A significantly greater EQ-5D (-0.14, 95% CI 0.08 to 0.28; p = 0.038) and a state that was not WTD (-0.14, 95% CI 0.01 to 0.26; p = 0.031) were associated with a deterioration in the EQ-5D. THA (0.21, 95% CI 0.07 to 0.34; p = 0.002) or a lower (better) CFS (0.14, 95% CI 0.07 to 0.20; p < 0.001) were independently significantly associated with a deterioration in the CFS. Conclusion Patients waiting more than six months for THA or KA had a significant deterioration in their HRQoL and increased frailty, with two-thirds of patients feeling that their health had worsened. Cite this article: Bone Joint J 2022;104-B(11):1215–1224.

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“…Offen ist, wie ein Trainingsprotokoll für Patient*innen, die zum Training nicht in eine Klinik kommen können oder wollen, gestaltet sein sollte, z. B. als Heimtraining mit Unterstützung einer entsprechenden Applikation 34 . Künftige Studien müssen zudem evaluieren, wie passend das PRELS-Programm auch für Personen mit stärker eingeschränkter Funktionsfähigkeit ist.…”

Section: Diskussionunclassified

Prähabilitation bei elektiver Lungen-Teilresektion (PRELS) – Eine Machbarkeitsstudie

et al. 2023

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Zusammenfassung Hintergrund Lungenkrebs weist die höchste krebsbedingte Sterblichkeitsrate auf. Die chirurgische Resektion bei nicht kleinzelligem Lungenkrebs im Frühstadium bildet den Grundstein der Behandlung. Thoraxchirurgische Eingriffe sind mit einer erhöhten Rate an postoperativen Komplikationen verbunden, insbesondere bei verminderter präoperativer Leistungsfähigkeit. Das Enhanced Recovery Protocol stellt einen evidenzbasierten Ansatz für die Versorgung von Patient*innen dar, wobei ein wachsendes Interesse am Wert der Prähabilitation besteht. Prähabilitationsprotokolle, die auf eine Verbesserung der postoperativen Genesung abzielen, wurden als eine Intervention zur Verringerung der post-chirurgischen Beschwerden vorgeschlagen. Bis heute gibt es in der Schweiz keine etablierten Protokolle für ein präoperatives, körperliches Training. Ziel Untersuchung der Machbarkeit eines präoperativen Trainingsprogramms für Patient*innen mit geplanter Lungenteilresektion. Methoden Im Rahmen einer multizentrischen Machbarkeitsstudie wurden an 4 Schweizer Kliniken je 1 Person in ein präoperatives Training aufgenommen. Die Intervention bestand aus einem ambulanten Übungsprogramm mit Krafttraining und High-Intensity Intervall-Ausdauertraining für mindestens 1 Woche vor dem chirurgischen Eingriff. Die Endpunkte der Studie waren die Durchführbarkeit der präoperativen Rehabilitation und der Assessments sowie eine erste Abschätzung der Effekte. Ergebnisse 4 Patient*innen wurden eingeschlossen. In allen Kliniken begannen die Patient*innen 21,5 ± 3 Tage vor der Operation mit dem Training, es gab keine Trainingsunterbrechungen. Es wurden keine unerwünschten Ereignisse beobachtet, was darauf hinweist, dass das präoperative Bewegungstraining sicher ist. Das vorgesehene Studiendesign konnte eingehalten werden. Die ausgewählten funktionellen Assessments sind durchführbar, sicher und die Ergebnisse sind für die Studie geeignet. Die Rekrutierung erwies sich jedoch als große Herausforderung. Diskussion Die Ergebnisse zeigen, dass ein präoperatives Training durchführbar ist. Um das Rekrutierungspotenzial voll auszuschöpfen, ist es notwendig, die Risikostratifizierung, die organisatorischen Abläufe der beteiligten Kliniken zu spezifizieren und eine hohe Kooperationsbereitschaft aller beteiligten Disziplinen sicherzustellen bzw. zu definieren. Schlussfolgerung Ein präoperatives, intensives Training vor einer geplanten Lungenteilresektion in 4 großen Spitälern der Schweiz war machbar. Es zeigten sich positive Effekte bezüglich Kraft und Ausdauer, zudem fühlten sich die Patient*innen in dieser Phase gut betreut. Ängste und Bedenken konnten frühzeitig adressiert und besprochen werden. Die Machbarkeitsstudie lieferte wertvolle Erkenntnisse für das Protokoll einer nachfolgenden Effektivitätsstudie.

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Fit4Surgery for cancer patients during covid-19 lockdown – A systematic review and meta-analysis

Cited by 10 publications

References 55 publications

Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty

Preoperative health-related quality of life is independently associated with postoperative mortality risk following total hip or knee arthroplasty

Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty

Prähabilitation bei elektiver Lungen-Teilresektion (PRELS) – Eine Machbarkeitsstudie

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