Prehabilitation, enhanced recovery after surgery, or both? A narrative review

Gillis, Chelsia; Ljungqvist, Olle; Carli, Francesco

doi:10.1016/j.bja.2021.12.007

Cited by 97 publications

(80 citation statements)

References 184 publications

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“…Increasing protein intake during periods of disuse before ACL reconstruction may restore anabolism and attenuate muscle loss to better prepare a patient for the metabolic demand for protein during surgery and early postoperative recovery (i.e., maintain 'reserve' of amino acids) [19,20]. Protein-based interventions before surgery may also enhance muscle regenerative capacity, as pre-operative EAA supplementation increased satellite cell abundance in total knee arthroplasty patients [21].…”

Section: Introductionmentioning

confidence: 99%

Effect of High-Protein Diets on Integrated Myofibrillar Protein Synthesis before Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Pilot Study

et al. 2022

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Increasing dietary protein intake during periods of muscle disuse may mitigate the resulting decline in muscle protein synthesis (MPS). The purpose of this randomized pilot study was to determine the effect of increased protein intake during periods of disuse before anterior cruciate ligament (ACL) reconstruction on myofibrillar protein synthesis (MyoPS), and proteolytic and myogenic gene expression. Six healthy, young males (30 ± 9 y) were randomized to consume a high-quality, optimal protein diet (OP; 1.9 g·kg − 1·d − 1) or adequate protein diet (AP; 1.2 g·kg − 1·d − 1) for two weeks before ACL reconstruction. Muscle biopsies collected during surgery were used to measure integrated MyoPS during the intervention (via daily deuterium oxide ingestion) and gene expression at the time of surgery. MyoPS tended to be higher, with a large effect size in OP compared to AP (0.71 ± 0.1 and 0.54 ± 0.1%·d − 1; p = 0.076; g = 1.56). Markers of proteolysis and myogenesis were not different between groups (p > 0.05); however, participants with greater MyoPS exhibited lower levels of MuRF1 gene expression compared to those with lower MyoPS (r = −0.82, p = 0.047). The data from this pilot study reveal a potential stimulatory effect of increased daily protein intake on MyoPS during injury-mediated disuse conditions that warrants further investigation.

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Section: Introductionmentioning

confidence: 99%

Effect of High-Protein Diets on Integrated Myofibrillar Protein Synthesis before Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Pilot Study

et al. 2022

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“…Most medical institutions across the United States have implemented Enhanced Recovery After Surgery (ERAS) protocols for a variety of surgical procedures ( Ljungqvist et al, 2021 ; Gillis et al, 2022 ). In brief, these protocols target early mobilization, multi-modal, non-opioid pain control, and early discharge from hospital.…”

Section: Managementmentioning

confidence: 99%

Mitigation of perioperative neurocognitive disorders: A holistic approach

Safavynia

Goldstein

Evered

2022

Front. Aging Neurosci.

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William Morton introduced the world to ether anesthesia for use during surgery in the Bullfinch Building of the Massachusetts General Hospital on October 16, 1846. For nearly two centuries, the prevailing wisdom had been that the effects of general anesthetics were rapidly and fully reversible, with no apparent long-term adverse sequelae. Despite occasional concerns of a possible association between surgery and anesthesia with dementia since 1887 (Savage, 1887), our initial belief was robustly punctured following the publication in 1998 of the International Study of Post-Operative Cognitive Dysfunction [ISPOCD 1] study by Moller et al. (1998) in The Lancet, in which they demonstrated in a prospective fashion that there were in fact persistent adverse effects on neurocognitive function up to 3 months following surgery and that these effects were common. Since the publication of that landmark study, significant strides have been made in redefining the terminology describing cognitive dysfunction, identifying those patients most at risk, and establishing the underlying etiology of the condition, particularly with respect to the relative contributions of anesthesia and surgery. In 2018, the International Nomenclature Consensus Working Group proposed new nomenclature to standardize identification of and classify perioperative cognitive changes under the umbrella of perioperative neurocognitive disorders (PND) (Evered et al., 2018a). Since then, the new nomenclature has tried to describe post-surgical cognitive derangements within a unifying framework and has brought to light the need to standardize methodology in clinical studies and motivate such studies with hypotheses of PND pathogenesis. In this narrative review, we highlight the relevant literature regarding recent key developments in PND identification and management throughout the perioperative period. We provide an overview of the new nomenclature and its implications for interpreting risk factors identified by clinical association studies. We then describe current hypotheses for PND development, using data from clinical association studies and neurophysiologic data where appropriate. Finally, we offer broad clinical guidelines for mitigating PND in the perioperative period, highlighting the role of Brain Enhanced Recovery After Surgery (Brain-ERAS) protocols.

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“…People with DM have a longer length of stay and higher postoperative complication rates than those without DM. A comprehensive care pathway from the UK Centre for Perioperative Care (CPOC) was published in March 2021 and provides guidelines on all aspects of care, from referral to discharge planning for people with DM [14] .…”

Section: Surgerymentioning

confidence: 99%

“…The CPOC guidelines outline the dosage adjustments for each type and formulation of insulin in the preoperative period [14] .…”

Section: Pharmacotherapymentioning

confidence: 99%

Metabolism and Target Organ Damage

Fearon¹,

Pournaras²

2022

Metab Target Organ Damage

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People with diabetes mellitus (DM) undergo more elective surgery than those without DM; however, up to half of the patients are undiagnosed when referred for surgery. This is an opportunity to intervene and instigate a management plan. Preoperative strategies may vary based on coexisting medical diseases such as obesity and the availability of resources with the aim of achieving glycaemic control while also treating coexisting conditions. In the context of obesity, there is substantial overlap in some of the treatment strategies. Guidelines, such as those from the UK Centre for Perioperative Medicine, suggest target glycated haemoglobin levels, preoperative fasting blood glucose levels, and when to defer an elective operation or instigate treatment to proceed if deemed safe. Preoperatively glycaemic control is often achieved pharmacologically, and newer agents, including glucagon-like peptide one receptor agonists (GLP1-RA) and sodium-glucose co-transporter 2 (SGLT2) inhibitors, are emphasised in the preoperative management of diabetes mellitus, particularly if obesity is also present. A very low-energy diet is an underutilised but well-evidenced method of achieving both glycaemic control and weight loss with a particularly dominant effect on liver fat which is helpful for people who are due to undergo abdominal surgery. Bariatric-metabolic procedures are of growing interest as bridging interventions to surgery and are more commonly used for obesity, but they also have a well-recognized impact on the improvement and remission of DM. This review gives an overview of the necessity of preoperative identification of DM and strategies for management. Intra-operative glycaemic control is also discussed, and the role of stress hyperglycaemia perioperatively.

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Prehabilitation, enhanced recovery after surgery, or both? A narrative review

Cited by 97 publications

References 184 publications

Effect of High-Protein Diets on Integrated Myofibrillar Protein Synthesis before Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Pilot Study

Effect of High-Protein Diets on Integrated Myofibrillar Protein Synthesis before Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Pilot Study

Mitigation of perioperative neurocognitive disorders: A holistic approach

Metabolism and Target Organ Damage

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