Prehabilitation: preparing patients for surgery

Wynter-Blyth, Venetia; Moorthy, Krishna

doi:10.1136/bmj.j3702

Cited by 164 publications

(114 citation statements)

References 8 publications

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“…Effective strategies for delirium prevention include proactive interdisciplinary collaboration, such as geriatrics consultation, frequent reorientation, nonpharmacologic sleep protocols, early mobilization, sensory aids, and minimization of psychoactive medication use . Another preventative strategy being studied is prehabilitation, a multimodal intervention to optimize a patient's resilience prior to surgery . Further research is warranted to investigate the role of rehabilitative interventions to mitigate the negative long‐term functional consequences in patients who develop delirium after these procedures.…”

Section: Discussionmentioning

confidence: 99%

“…1,38,39 Another preventative strategy being studied is prehabilitation, a multimodal intervention to optimize a patient's resilience prior to surgery. 40 Further research is warranted to investigate the role of rehabilitative interventions to mitigate the negative long-term functional consequences in patients who develop delirium after these procedures.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement

Shi

Sung

Afilalo

et al. 2019

J American Geriatrics Society

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Background Transcatheter aortic valve replacement (TAVR) may be associated with less delirium and allow faster recovery than surgical aortic valve replacement (SAVR). Objective To examine the association of delirium and its severity with clinical and functional outcomes after SAVR and TAVR. Design Prospective cohort study. Setting An academic medical center. Participants A total of 187 patients, aged 70 years and older, undergoing SAVR (N = 77) and TAVR (N = 110) in 2014 to 2016. Measurements Delirium was assessed daily using the Confusion Assessment Method (CAM), with severity measured by the CAM‐Severity (CAM‐S) score (range = 0‐19). Outcomes were prolonged hospitalization (9 days or more); institutional discharge; and functional status, measured by ability to perform 22 daily activities and physical tasks over 12 months. Results SAVR patients had a higher incidence of delirium than TAVR patients (50.7% vs 25.5%; P < .001), despite younger mean age (77.9 vs 83.7 years) and higher baseline Mini‐Mental State Examination score (26.9 vs 24.7). SAVR patients with delirium had a shorter duration (2.2 vs 3.4 days; P = .04) with a lower mean CAM‐S score (4.5 vs 5.7; P = .01) than TAVR patients with delirium. The risk of prolonged hospitalization in no, mild, and severe delirium was 18.4%, 30.8%, and 61.5% after SAVR (P for trend = .009) and 26.8%, 38.5%, and 73.3% after TAVR (P for trend = .001), respectively. The risk of institutional discharge was 42.1%, 58.3%, and 84.6% after SAVR (P for trend = .01) and 32.5%, 69.2%, and 80.0% after TAVR (P for trend <.001), respectively. Severe delirium was associated with delayed functional recovery after SAVR and persistent functional impairment after TAVR at 12 months. Conclusion Less invasive TAVR was associated with lower incidence of delirium than SAVR. Once delirium developed, TAVR patients had more severe delirium and worse functional status trajectory than SAVR patients did. Registration NCT01845207.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement

Shi

Sung

Afilalo

et al. 2019

J American Geriatrics Society

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“…Patients not only need to prepare physiologically for the demands of surgery but they also need to be mentally fit; it is increasingly acknowledged that prehabilitation should include psychological components . Pre‐operative anxiety, depression and low self‐efficacy are consistently associated with worse physiological surgical outcomes and quality of life.…”

Section: Conclusion and Future Directions For Researchmentioning

confidence: 99%

Psychological factors, prehabilitation and surgical outcomes: evidence and future directions

2019

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The pre-operative optimisation of comorbidities is increasingly recognised as an important element of the pre-operative pathway. These efforts have primarily focused on physical comorbidities such as anaemia and the optimisation of exercise and nutrition. However, there is a growing recognition of the importance of psychological morbidity. Increasingly, evidence suggests that psychological factors have an impact on surgical outcomes in both the short and long term. Pre-operative anxiety, depression and low self-efficacy are consistently associated with worse physiological surgical outcomes and postoperative quality of life. This has led to the emergence of psychological prehabilitation and the trimodal approach to prehabilitation, incorporating psychological intervention as well as exercise and nutritional optimisation. However, there is currently insufficient evidence to be sure that pre-operative psychological interventions are of benefit, or which interventions are most effective, because their impact has been mixed. There is an urgent need for high quality, contemporaneous prospective trials with baseline psychological evaluation, well-described interventions and agreement on the most appropriate psychological, quality of life and physiological outcomes measures.

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“…Combinations of text messaging and apps have delivered weightbased educational modules to pre-operative bariatric patients (Mundi et al, 2015), a web-based platform has provided dietary advice to post-operative breast cancer patients (Lee et al, 2014), and videoconferencing has supported physical rehabilitation post-orthopedic surgery (Russell et al, 2011). Studies have acknowledged patient receptiveness towards using digital technologies to complement care, resulting in behavioral change, improved recovery time, and reduced length of stay in the hospital (Grocott et al, 2017;Wynter-Blyth & Moorthy, 2017;Wolfstadt et al, 2019). Digital technologies have empowered patients to play active roles in their surgical recoveries (Lee et al, 2014); however, fewer studies have implemented technologies to support patients pre-operatively.…”

Section: Introductionmentioning

confidence: 99%

The value of teachable moments in surgical patient care and the supportive role of digital technologies

et al. 2020

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Evidence strongly supports improved outcomes following surgery when patients are more physically active, have better dietary intake, or are generally fitter prior to surgery. Having an operation is a major life event for patients, and many are not educated around what they can do as individuals to aid a speedier and more successful recovery following their operation. What if there was a time point before surgery where clinicians could inspire patients to adjust their lifestyles for the better, in order to see fewer complications after surgery? This is where the concept of teachable moments comes into play. This commentary explores the concept of teachable moments and their value in surgical patient care and discusses the potentially under-utilized opportunities on hand to the surgical multidisciplinary team to remotely support patients using digital health technologies.

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Prehabilitation: preparing patients for surgery

Abstract: Major surgery is like running a marathon—and both require training

Cited by 164 publications

References 8 publications

Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement

Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement

Psychological factors, prehabilitation and surgical outcomes: evidence and future directions

The value of teachable moments in surgical patient care and the supportive role of digital technologies

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