Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

Berkel, Annefleur E M; Wijk, Laura van; Bongers, Bart C.; Palen, Job van der; Buis, Carlijn I.; Reudink, Muriël; Liem, Mike S L; Slooter, Gerrit D.; Meeteren, N.L.U. van; Klaase, Joost M.

doi:10.18203/2349-3259.ijct20201716

Cited by 3 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Four patients did not undergo a CPET due to severe knee problems; five others could not have a CPET (re)scheduled because they had intermittent hospital admissions due to cholangitis (2 patients) or portal vein embolisation (1), or because they missed their initial CPET appointment due to another appointment at the hospital taking longer than expected (2). Of the patients who did undergo a CPET, 17 (52%) had an AT ≤ 11 mL/kg/min; among them, 15 were requested to enrol in the PRIOR study (preoperative home prehabilitation for patients planned for pancreatic or liver resection) (Berkel et al 2020 ). One patient ended up undergoing radiofrequency ablation, which is an exclusion criterion for the PRIOR study.…”

Section: Resultsmentioning

confidence: 99%

“…An AT ≤ 11 mL/kg/min was defined as low cardiorespiratory fitness, and those patients were considered at high risk (Wilson et al 2010 ). Patients with an anaerobic threshold ≤ 11 mL/kg/min were asked to participate in the PRIOR study (Netherlands Trial Register [NL6151]), a personalised home-based exercise prehabilitation programme (Berkel et al 2020 ). Furthermore, patients who had an AT > 11 mL/kg/min were encouraged to follow the global recommendations on exercise (World Health Organization 2010 ).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction Despite improvements in perioperative care, major abdominal surgery continues to be associated with significant perioperative morbidity. Accurate preoperative risk stratification and optimisation (prehabilitation) are necessary to reduce perioperative morbidity. This study evaluated the screening and assessment of modifiable risk factors amendable for prehabilitation interventions and measured the patient compliance rate with recommended interventions. Method Between May 2019 and January 2020, patients referred to our hospital for HPB surgery were screened and assessed on six modifiable preoperative risk factors. The risk factors and screening tools used, with cutoff values, included (i) low physical fitness (a 6-min walk test < 82% of patient’s calculated norm and/or patient’s activity level not meeting the global recommendations on physical activity for health). Patients who were unfit based on the screening were assessed with a cardiopulmonary exercise test (anaerobic threshold ≤ 11 mL/kg/min); (ii) malnutrition (patient-generated subjective global assessment ≥ 4); (iii) iron-deficiency anaemia (haemoglobin < 12 g/dL for women, < 13 g/dL for men and transferrin saturation ≤ 20%); (iv) frailty (Groningen frailty indicator/Robinson frailty score ≥ 4); (v) substance use (smoking and alcohol use of > 5 units per week) and (vi) low psychological resilience (Hospital Anxiety and Depression Scale ≥ 8). Patients had a consultation with the surgeon on the same day as their screening. High-risk patients were referred for necessary interventions. Results One hundred consecutive patients were screened at our prehabilitation outpatient clinic. The prevalence of high-risk patients per risk factor was 64% for low physical fitness, 42% for malnutrition, 32% for anaemia (in 47% due to iron deficiency), 22% for frailty, 12% for smoking, 18% for alcohol use and 21% for low psychological resilience. Of the 77 patients who were eventually scheduled for surgery, 53 (68.8%) needed at least one intervention, of whom 28 (52.8%) complied with 100% of the necessary interventions. The median (IQR) number of interventions needed in the 77 patients was 1.0 (0–2). Conclusion It is feasible to screen and assess all patients referred for HPB cancer surgery for six modifiable risk factors. Most of the patients had at least one risk factor that could be optimised. However, compliance with the suggested interventions remains challenging.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…A complete description of the methodology for this multicentre study is available in Appendix S1 and in the previously published study protocol 11 . In brief, using a pretest–post-test design, high-risk patients (preoperative oxygen uptake ( V O 2 ) at the ventilatory anaerobic threshold (VAT) 11 ml per kg per min or less) scheduled for elective liver or pancreatic resection, and who provided informed consent, participated in a 4-week semisupervised home-based exercise programme (12 sessions in total).…”

Section: Methodsmentioning

confidence: 99%

Improved preoperative aerobic fitness following a home-based bimodal prehabilitation programme in high-risk patients scheduled for liver or pancreatic resection

Wijk

Bongers

Berkel

et al. 2022

British Journal of Surgery

View full text Add to dashboard Cite

“…The database consisted of CPETs performed on a cycle ergometer (Monark Exercise LC6, Vansbro, Sweden) in upright position using a breath-by-breath CPET system (Quark CPET, COSMED Srl, Rome, Italy) between March 2019 and March 2020. A detailed description of the CPET protocol can be found elsewhere [ 17 ]. The CPET protocol comprised a two-minute resting phase, a three-minute warm-up of unloaded cycling, and an incremental phase with constant work rate increments of 5, 10, or 15 W/min, depending on the patient’s estimated physical fitness level and aimed at reaching a maximal effort within eight to 12 min.…”

Section: Methodsmentioning

confidence: 99%

Inter-observer agreement of preoperative cardiopulmonary exercise test interpretation in major abdominal surgery

Franssen

Eversdijk

Kuikhoven³

et al. 2022

BMC Anesthesiol

Self Cite

View full text Add to dashboard Cite

Background Accurate determination of cardiopulmonary exercise test (CPET) derived parameters is essential to allow for uniform preoperative risk assessment. The objective of this prospective observational study was to evaluate the inter-observer agreement of preoperative CPET-derived variables by comparing a self-preferred approach with a systematic guideline-based approach. Methods Twenty-six professionals from multiple centers across the Netherlands interpreted 12 preoperative CPETs of patients scheduled for hepatopancreatobiliary surgery. Outcome parameters of interest were oxygen uptake at the ventilatory anaerobic threshold (V̇O2VAT) and at peak exercise (V̇O2peak), the slope of the relationship between the minute ventilation and carbon dioxide production (V̇E/V̇CO2-slope), and the oxygen uptake efficiency slope (OUES). Inter-observer agreement of the self-preferred approach and the guideline-based approach was quantified by means of the intra-class correlation coefficient. Results Across the complete cohort, inter-observer agreement intraclass correlation coefficient (ICC) was 0.76 (95% confidence interval (CI) 0.57–0.93) for V̇O2VAT, 0.98 (95% CI 0.95–0.99) for V̇O2peak, and 0.86 (95% CI 0.75–0.95) for the V̇E/V̇CO2-slope when using the self-preferred approach. By using a systematic guideline-based approach, ICCs were 0.88 (95% CI 0.74–0.97) for V̇O2VAT, 0.99 (95% CI 0.99–1.00) for V̇O2peak, 0.97 (95% CI 0.94–0.99) for the V̇E/V̇CO2-slope, and 0.98 (95% CI 0.96–0.99) for the OUES. Conclusions Inter-observer agreement of numerical values of CPET-derived parameters can be improved by using a systematic guideline-based approach. Effort-independent variables such as the V̇E/V̇CO2-slope and the OUES might be useful to further improve uniformity in preoperative risk assessment in addition to, or in case V̇O2VAT and V̇O2peak are not determinable.

show abstract

Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

Cited by 3 publications

References 31 publications

A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions

A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions

Improved preoperative aerobic fitness following a home-based bimodal prehabilitation programme in high-risk patients scheduled for liver or pancreatic resection

Inter-observer agreement of preoperative cardiopulmonary exercise test interpretation in major abdominal surgery

Contact Info

Product

Resources

About