The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review

Bruns, Emma R J; Heuvel, Baukje van den; Buskens, C J; Duijvendijk, Peter van; Festen, Suzanne; Wassenaar, Eelco B.; Zaag, Edwin S. van der; Bemelman, Willem A.; Munster, Barbara C. Van

doi:10.1111/codi.13429

Cited by 161 publications

(121 citation statements)

References 57 publications

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Section: Discussionmentioning

confidence: 99%

“…Further-more, performing laparoscopic cholecystectomy on elderly patients has resulted in increased postoperative complications such as increased morbidity, biliary tract disease, and longer hospital stays 7 . These severe postoperative outcomes have been attributed to the lack of muscle strength and poor physical condition associated with the older patient population 7,8 . Though studies have found that laparoscopic cholecystectomy may cause less post-operative complications in general, it is still linked to longer operation time, pro-longed hospital stay, and higher morbidity in geriatric patients compared to the younger ones 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the increasing number of elderly patients undergoing laparoscopic surgery along with the associated co-morbidity factors, there is still a lack of research studies investigating risks older patients endure after undergoing such procedures 7 . Therefore, defining patient segments (such as geriatric patients) who are specifically at risk of postoperative complications and standardizing the outcome is of extreme importance to improve postoperative results.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, investigating the postoperative outcomes in the geriatric population will have dramatic implications on prehabilitation where the preoperative condition of a patient is enhanced as a means to improve his/her postoperative outcome 7 . This can be a valid option in patients going for elective laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

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Implications of Education and Prehabilitation on the Geriatric Surgical Patient

Hufford¹,

Rubin²,

Al-Qudah³

et al. 2017

Preprint

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INTRODUCTION Recently there has been a significant increase in age in the United States. It is necessary to better understand the physiological and surgical needs of these patients in order to optimize outcomes. The vast majority of procedures performed in adult patients are low-risk operations, such as laparoscopic cholecystectomy. Our aim is to investigate the outcomes, including length of stay, morbidity, mortality, re-admission and discharge disposition of the elderly population (>80) undergoing low-risk operations in our tertiary community hospital. METHODS A retrospective chart review was done at a tertiary community hospital. The time frame utilized was 2011-2015. Patients were excluded only on the basis of their age (< 80) at the time of operation. RESULTS There were a total of 30 patients who underwent laparoscopic cholecystectomy from 2011 to 2015. 21 patients (70%) were female and 9 (30%) were male. No patients were converted to an open procedure. The average age was 86.4 years and average ASA classification prior to surgery was 2.88. Higher ASA class, specifically those that were class III/IV were more likely to have an increased length of stay that was statistically significant. Overall age greater than 80 was an independent risk factor for transfer to a higher level of care upon discharge (SNF, LTAC, etc.), a surrogate marker for physical decompensation following surgery. CONCLUSIONS Routine surgery, such as the laparoscopic cholecystectomy, effects the elderly population in a more substantial way, and early recognition coupled with increased education for physicians regarding geriatric patients can help to reduce length of stay, morbidity, and overall physical and mental deconditioning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Implications of Education and Prehabilitation on the Geriatric Surgical Patient

Hufford¹,

Rubin²,

Al-Qudah³

et al. 2017

Preprint

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“…11 In a recent study of Barberan-Garcia et al in high-risk patients who underwent elective major abdominal surgery, exercise prehabilitation not only improved preoperative aerobic fitness, but also resulted in a 51% reduction in postoperative complications compared to the usual care group. [8][9][10][11][12] Most preoperative training programs were carried out under supervision in an outpatient clinic; however, a personalized exercise program in a home-based setting might enhance the participation rate, motivation, and adherence of (high-risk) patients, and has proven to be the preferred method for a prehabilitation program. 11,13,14 Although several studies investigated the effects of exercise prehabilitation in liver and/or pancreatic resection and reported positive effects on physical fitness and postoperative morbidity, there is limited evidence addressing the feasibility and effectiveness of supervised home-based prehabilitation in these populations.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background: Controversial evidence currently exists regarding the feasibility and effectiveness to improve preoperative aerobic fitness during home-based prehabilitation in patients scheduled for liver or pancreatic resection, whereas morbidity rates are high following these resections. The primary aim of this study is to evaluate the preoperative oxygen uptake (VO 2 ) at the ventilatory anaerobic threshold before and after a four-week home-based preoperative training program with nutritional supplementation in high-risk patients scheduled for elective liver or pancreatic resection. Secondary aims are to evaluate program feasibility, immune system function, cardiopulmonary exercise test responses, individual progression profiles on training responses, quality of life, and postoperative course. Methods: In this multicenter study with a pretest-posttest design, patients with a liver or pancreatic tumor scheduled for elective resection will be recruited. To select the high-risk fraction of this surgical population, their VO 2 at the ventilatory anaerobic threshold should be <11 ml/kg/min for final inclusion. A planned total of 24 high-risk patients will participate in a four-week (three sessions per week) home-based bimodal prehabilitation program. The partly supervised home-based preoperative training program consists of individualized goal setting followed by titration of interval and endurance training on an advanced cycle ergometer, combined with functional task exercises. Additionally, patients will be given protein and vitamin/mineral supplementation. Discussion: Effects of a partly supervised home-based bimodal prehabilitation regimen are unknown in high-risk patients opting for liver or pancreatic resection. Improved preoperative aerobic fitness might translate into improved postoperative outcomes and a reduced demand on care resources.

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Association of Preoperative High-Intensity Interval Training With Cardiorespiratory Fitness and Postoperative Outcomes Among Adults Undergoing Major Surgery

et al. 2023

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ImportancePreoperative high-intensity interval training (HIIT) is associated with improved cardiorespiratory fitness (CRF) and may improve surgical outcomes.ObjectiveTo summarize data from studies comparing the association of preoperative HIIT vs standard hospital care with preoperative CRF and postoperative outcomes.Data SourcesData sources included Medline, Embase, Cochrane Central Register of Controlled Trials Library, and Scopus databases with no language constraints, including abstracts and articles published before May 2023.Study SelectionThe databases were searched for randomized clinical trials and prospective cohort studies with HIIT protocols in adult patients undergoing major surgery. Thirty-four of 589 screened studies met initial selection criteria.Data Extraction and SynthesisA meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data were extracted by multiple independent observers and pooled in a random-effects model.Main Outcomes and MeasuresThe primary outcome was change in CRF, as measured by either peak oxygen consumption (V̇o2 peak) or 6-Minute Walk Test (6MWT) distance. Secondary outcomes included postoperative complications; hospital length of stay (LOS); and changes in quality of life, anaerobic threshold, and peak power output.ResultsTwelve eligible studies including 832 patients were identified. Pooled results indicated several positive associations for HIIT when compared with standard care either on CRF (V̇o2 peak, 6MWT, anaerobic threshold, or peak power output) or postoperative outcomes (complications, LOS, quality of life), although there was significant heterogeneity in study results. In 8 studies including 627 patients, there was moderate-quality evidence of significant improvement in V̇o2 peak (cumulative mean difference, 2.59 mL/kg/min; 95% CI, 1.52-3.65 mL/kg/min; P &lt; .001). In 8 studies including 770 patients, there was moderate-quality evidence of a significant reduction in complications (odds ratio, 0.44; 95% CI, 0.32-0.60; P &lt; .001). There was no evidence that HIIT differed from standard care in hospital LOS (cumulative mean difference, −3.06 days; 95% CI, −6.41 to 0.29 days; P = .07). The analysis showed a high degree of heterogeneity in study outcomes and an overall low risk of bias.Conclusions and RelevanceThe results of this meta-analysis suggest that preoperative HIIT may be beneficial for surgical populations through the improvement of exercise capacity and reduced postoperative complications. These findings support including HIIT in prehabilitation programs before major surgery. The high degree of heterogeneity in both exercise protocols and study results supports the need for further prospective, well-designed studies.

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The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review

Cited by 161 publications

References 57 publications

Implications of Education and Prehabilitation on the Geriatric Surgical Patient

Implications of Education and Prehabilitation on the Geriatric Surgical Patient

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

Association of Preoperative High-Intensity Interval Training With Cardiorespiratory Fitness and Postoperative Outcomes Among Adults Undergoing Major Surgery

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