Prehabilitation in gynecological surgery? What do gynecologists know and need to know

Ebner, Florian; Schulz, Sebastian; Gregorio, Amelie de; Volz, S.; Steinacker, Jürgen M.; Janni, Wolfgang; Otto, Stephanie

doi:10.1007/s00404-017-4565-8

“…Few gynecologic prehabilitation studies have been conducted, and available studies have focused exclusively on pre- and post-operative functional exercises with conflicting results 18. Studies for multimodal prehabilitation before surgery in other abdominal cancers have shown a positive impact on patient outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Few gynecologic prehabilitation studies have been conducted, and available studies have focused exclusively on pre-and post-operative functional exercises with conflicting results. 18 Studies for multimodal prehabilitation before surgery in other abdominal cancers have shown a positive impact on patient outcomes. A meta-analysis in colorectal surgery found that nutrition prehabilitation with and without exercise shortened length of hospital stay by 2 days in a largely traditional (ie, non-ERAS) surgical care setting.…”

Section: Prehabilitationmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

²

,

Kalogera

³

et al. 2019

Int J Gynecol Cancer

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BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

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“…Inevitably, it will damage the pelvic floor function [ 6 , 7 ]. Accelerated rehabilitation surgery (ERAS) was systematically proposed and implemented by Danish surgeon Kehlet et al In 2001, through the application of a series of optimization measures with evidence-based medical evidence in the perioperative period, ERAS can reduce the psychological and physiological trauma stress response of patients and promote the rapid recovery of patients [ 8 , 9 ]. Currently, in the world, the ERAS nursing concept has been widely implemented as a standard scheme for perioperative treatment of colorectal diseases and gradually extended to orthopedics, gynecology, thoracic surgery, etc.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Image under Artificial Intelligence Algorithm to Evaluate the Intervention Effect of Accelerated Rehabilitation Surgery Nursing on Laparoscopic Hysterectomy

Yu

¹

,

Zhao

²

,

Duan

³

et al. 2022

Computational Intelligence and Neuroscience

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To explore the application value of accelerated rehabilitation surgery (ERAS) nursing in laparoscopic total hysterectomy, 120 patients who underwent laparoscopic total hysterectomy for benign uterine diseases in the hospital were selected as the research object. According to different nursing schemes, they were divided into 60 cases in the experimental group (ERAS nursing program) and 60 cases in the control group (traditional perioperative nursing). All patients underwent postoperative ultrasonography, and the intraoperative and postoperative rehabilitation indexes of the two groups were analyzed. Moreover, an improved standard Capon beamforming (ISCB) algorithm is proposed, which is compared with SCB algorithm, sequential regression algorithm (SER), and recursive least square (RLS) algorithm. The results showed that the center average power and background average power (−46.92, −33.85) of the ISCB algorithm were significantly lower than those of SCB algorithm (−36.18, −23.64), SER algorithm (−39.02, −27.31), and RLS algorithm (−34.88, −24.66), while the contrast and resolution (19.11, 15.57) were significantly higher than those of SCB algorithm (12.74, 9.01), SER algorithm (13.86, 7.89), and RLS algorithm (13.26, 8.26) P < 0.05 . The anal exhaust time (11.84 ± 2.15 hours), analgesic effect score (3.37 ± 1.03 points), hospitalization days (3.72 ± 0.74 days), and hospitalization expenses (11859.03 ± 735.24 ¥) in the experimental group were significantly lower than those in the control group (20.95 ± 3.44 hours, 6.12 ± 1.46 points, 5.48 ± 0.91 days, 16135.22 ± 680.55 ¥) P < 0.05 . The score of NRS evaluation scale in the experimental group (2.28 ± 0.37) was significantly better than that in the control group (4.09 ± 0.65) P < 0.05 . The proportion of patients in the experimental group (very satisfied + satisfied + generally satisfied) (100%) was significantly better than that in the control group (71%), and the difference was statistically significant P < 0.05 . In the experimental group, there were 2 cases of postoperative fever, 1 case of nausea and vomiting, and 2 cases of lower extremity venous thrombosis. In the control group, there were 4 cases of postoperative fever, 4 cases of nausea and vomiting, and 2 cases of lower extremity venous thrombosis. In summary, ultrasound imaging based on the ISCB algorithm can display the pelvic floor structure of patients undergoing laparoscopic total hysterectomy with high quality and improve the diagnostic rate of doctors. ERAS nursing can accelerate patients’ postoperative rehabilitation, reduce postoperative pain, and improve patients’ satisfaction. It was worthy to be popularized and applied in the clinic.

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“…There are few studies published on prehabilitation programs in gynecologic surgery, and even fewer in gynecologic oncology patients. 45 Carli et al provided a detailed prehabilitation strategy on a frail elderly patient with endometrial cancer who underwent robotic-assisted total hysterectomy. The patient underwent physical, nutritional, and psychological assessments before a 3-week prehabilitation home-based program consisting of exercise and nutritional optimization.…”

Section: Prehabilitation In Gynecological Surgerymentioning

confidence: 99%

Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

Miralpeix

¹

,

Mancebo

²

,

Gayete

³

et al. 2019

Int J Gynecol Cancer

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Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.

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Prehabilitation in gynecological surgery? What do gynecologists know and need to know

Abstract: Unlike other disciplines where prehabilitation has been studied, a gynecologic viewpoint still needs establishing and further studies are needed to clarify the benefit for the patients.

Cited by 21 publications

References 12 publications

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Ultrasound Image under Artificial Intelligence Algorithm to Evaluate the Intervention Effect of Accelerated Rehabilitation Surgery Nursing on Laparoscopic Hysterectomy

Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

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