Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomised controlled trial

Barberán-García, Anael; Ubré, Marta; Roca, Jordi; Lacy, Antonio M.; Burgos, Felip; Risco, Raquel; Momblán, Dulce; Balust, Jaume; Blanco, Isabel; Martínez-Pallí, Graciela

doi:10.1183/1393003.congress-2017.oa1767

Cited by 132 publications

(302 citation statements)

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“…Four systematic reviews were eligible for inclusion [2][3][4][5]. Four recently published randomised controlled trials that we were aware of were also included [32][33][34][35]. These studies had not been included in any of the included reviews, so their inclusion provided a more comprehensive representation of the current evidence base.…”

Section: Pre-operative Exercise Training: Evidence and Recommendationsmentioning

confidence: 99%

“…All reviews used recognised tools to assess methodological risk of bias in their included studies. Of the four additional trials we identified, two included patients awaiting elective abdominal aortic aneurysm repair [34,35], one included patients awaiting lung resection surgery for non-small cell lung cancer [33], and one included adults aged ≥ 70 years undergoing major abdominal surgery [32].…”

Section: Pre-operative Exercise Training: Evidence and Recommendationsmentioning

confidence: 99%

“…In the systematic review by Hijazi et al [3], three trials that included a variety of abdominal surgical populations recorded complications using the Clavien-Dindo classification, with none of them reporting significant between-group differences [36,37,41]. A recent trial of 144 patients undergoing major abdominal surgery also reported no effect of pre-operative exercise training on the severity of complications assessed using the Clavien-Dindo classification [32]; however, the proportion of patients with postoperative complications was lower (31% vs. 62%; relative risk ratio (95%CI) 0.5 (0.3-0.8)) when complications were defined as any deviation from the normal postoperative course according to the standards of the European Society of Anaesthesiology and European Society of Intensive Care Medicine [42]. Finally, out of the two trials that have included patients undergoing elective abdominal aortic aneurysm repair [34,35], one showed a lower incidence of postoperative cardiac, pulmonary and/or renal complications in the exercise group vs. control (22.6% vs. 41.9%, RR = 0.54, p = 0.021) [34], whereas the other showed no substantial difference in mean total Postoperative Morbidity Survey count up to the point of discharge from hospital (2.3 vs. 2.1; difference (95%CI) 0.2 (À0.3 to 0.7)) [35].…”

Section: Peri-operative Clinical Outcomesmentioning

confidence: 99%

“…In a systematic review of pre-operative exercise training before major intra-abdominal surgery [4], a meta-analysis of four studies (232 patients) showed no significant difference in length of stay between exercise and control groups (mean difference (95%CI) À1.62 days (À7.57 to 4.33)), with the quality of evidence rated as 'very low'. Other trial evidence is mixed, with two studies showing some evidence of reduced length of stay [32,34], and one showing no substantial difference [35].…”

Section: Hospital Length Of Staymentioning

confidence: 99%

“…Data on exercise-related adverse events were presented in one of the systematic reviews [5] and all four of the additional trials [32][33][34][35]. The review of Loughney et al [5] cited the results of a study exploring the safety and efficacy of aerobic exercise training in people with operable breast cancer receiving neoadjuvant chemotherapy [40].…”

Section: Exercise-related Adverse Eventsmentioning

confidence: 99%

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Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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SummaryDespite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations. Summary of key recommendations1 Pre-operative exercise training should be offered to patients scheduled for major or complex elective surgery with a view to improving their physical fitness and health status and reducing the risk of peri-operative morbidity and mortality. If resources are limited, priority of referral to preoperative exercise training should go to patients who are at increased risk of peri-operative complications, such as those with low cardiorespiratory fitness.2 Pre-operative exercise training should be offered as part of a multi-modal prehabilitation programme that addresses a variety of peri-operative risk factors including cigarette smoking, excessive alcohol consumption, and anaemia. 3 Healthcare professionals making referrals to a preoperative exercise programme should have basic knowledge about what the programme entails and its potential effects. A pre-operative exercise programme should be presented to the patient by the referring clinician as a fundamental part of their 750

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Section: Pre-operative Exercise Training: Evidence and Recommendationsmentioning

confidence: 99%

Section: Pre-operative Exercise Training: Evidence and Recommendationsmentioning

confidence: 99%

Section: Peri-operative Clinical Outcomesmentioning

confidence: 99%

Section: Hospital Length Of Staymentioning

confidence: 99%

Section: Exercise-related Adverse Eventsmentioning

confidence: 99%

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Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery

et al. 2018

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Frailty and surgical outcomes in gastrointestinal cancer: Integration of geriatric assessment and prehabilitation into surgical practice for vulnerable patients

Mima

Nakagawa

Miyata

et al. 2022

Annals of Gastroent Surgery

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As life expectancy increases, the older population continues to grow rapidly, resulting in increased requirement for surgery for older patients with gastrointestinal cancer. Older individuals represent a heterogeneous group in terms of physiological reserves, co‐morbidity, cognitive impairment, and disability. Owing to the lack of treatment guidelines for vulnerable patients with gastrointestinal cancer, these patients are more likely to be at risk of undertreatment or overtreatment. Hence, the identification of frail patients with gastrointestinal cancer would improve cancer treatment outcomes. Although there is no standardized geriatric assessment tool, a growing body of research has shown associations of frailty with adverse postoperative outcomes and poor prognosis after resection of gastrointestinal tract and hepatobiliary‐pancreatic cancers. Emerging evidence suggests that prehabilitation, which includes exercise and nutritional support, can improve preoperative functional capacity, postoperative recovery, and surgical outcomes, particularly in frail patients with gastrointestinal cancer. We reviewed major geriatric assessment tools for identification of frail patients and summarized clinical studies on frailty and surgical outcomes, as well as prehabilitation or rehabilitation in gastrointestinal tract and hepatobiliary‐pancreatic cancers. The integration of preoperative geriatric assessment and prehabilitation of frail patients in clinical practice may improve surgical outcomes. In addition, improving preoperative vulnerability and preventing functional decline after surgery is important in providing favorable long‐term survival in patients with gastrointestinal cancer. Further clinical trials are needed to examine the effects of minimally invasive surgery, and chemotherapy in frail patients with gastrointestinal cancer.

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Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomised controlled trial

Cited by 132 publications

References 0 publications

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery

Frailty and surgical outcomes in gastrointestinal cancer: Integration of geriatric assessment and prehabilitation into surgical practice for vulnerable patients

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