#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#
CS
proLékaře.cz / Journals / Perspectives in Surgery / 2023 - 7

Prehabilitation bundle can reduce incidence of postoperative pulmonary complications

Czech version

Authors: O. Ryska 1,2;  A. Dereham 2;  S. Mahmoud 2;  N. Helmy 2;  E. Janta 2
Authors‘ workplace: Ústav živočišné fyziologie a genetiky Akademie věd České republiky, v. v. i., Liběchov, Česká republika 1;  Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, United Kingdom 2
Published in: Rozhl. Chir., 2023, roč. 102, č. 7, s. 277-282.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2023.102.7.277–282

Overview

Introduction: Elective major colorectal surgery is still associated with postoperative morbidity and mortality. Preoperative optimization can potentially reduce postoperative pulmonary complications, which significantly prolong recovery and increase the risk of mortality. The aim of this study was to evaluate the effect of the prehabilitation bundle on postoperative pulmonary complications.

Methods: All patients undergoing elective colorectal procedure for benign or malignant diagnosis before and after the introduction of the prehabilitation bundle were enrolled in the study. Prehabilitation was focused on nutritional support, regular aerobic and muscle strength exercise, preoperative optimization of anaemia, improvement of oral hygiene including regular chlorhexidine mouth wash, psychological support, restriction of smoking and alcohol consumption. In addition to the general characteristics, compliance with individual measures, incidence of pulmonary complications and length of stay were monitored.

Results: A total of 596 patients were included in the study (226 before and 370 after the implementation of the package). After the introduction of prehabilitation, the incidence of postoperative pulmonary complications decreased significantly − 29 (13%) vs. 17 (4.6%), RR: 0.21−0.67), p=0.001 and shorter length of stay was observed à 9.7 (±8.8) to 7.7 (±5.5) days (p=0.0005). Except for optimization of anaemia, compliance with the individual components of the established bundle was very good.

Conclusion: Introduction of a prehabilitation bundle focused on improvement of cardiorespiratory capacity, optimization of diet and oral hygiene, can reduce the risk of postoperative pulmonary complications and shorten the length of stay.

Keywords:

colorectal surgery – prehabilitation – postoperative pulmonary complications

Sources
  1. Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005 Sep;242(3):326−341. doi:10.1097/01.sla.0000179621.33268.83.
  2. West ME, Wischmeyer PE, Grocott MPW. Prehabilitation and nutritional support to improve perioperative outcomes. Curr Anesthesiol Rep. 2017;7(4):340−349. doi:10.1007/s40140-017-0245-2.
  3. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017 Mar 1;118(3):317−334. doi:10.1093/bja/aex002.
  4. Heger P, Probst P, Wiskemann J, et al. A systematic review and meta-analysis of physical exercise prehabilitation in major abdominal surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg. 2020 Jun;24(6):1375−1385. doi:10.1007/ s11605-019-04287-w.
  5. Wilson RJT, Davies S, Yates D, et al. Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth. 2010 Sep;105(3):297−303.doi:10.1093/bja/aeq128.
  6. Baldini G, Ferreira V, Carli F, et al. Preoperative preparations for enhanced recovery after surgery programs: A role for prehabilitation. Surg Clin North Am. 2018 Dec;98(6):1149−1169. doi: 10.1016/j.suc. 2018.07.004.
  7. Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021 Jul;40(7):4745−4761.doi:10.1016/j.clnu.2021.03.031.
  8. Keeler BD, Dickson EA, Simpson JA, et al. The impact of pre-operative intravenous iron on quality of life after colorectal cancer surgery: outcomes from the intravenous iron in colorectal cancer-associated anaemia (IVICA) trial. Anaesthesia 2019  Jun;74(6):714−725.  doi:10.1111/anae.14659.
  9. Egholm JWm, Pedersen B, Møller AM, et al. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database Syst Rev. 2018 Nov 8;11(11):CD008343. doi:10.1002/ 14651858.CD008343.pub3.
  10. Rachael P, Scott NW, Manyande A, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev. 2016 May 26;2016(5): CD008646. doi:10.1002/14651858.CD008646.pub2.
  11. Gillis C, Fenton TR, Sajobi TT, et al. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clin Nutr. 2019 Jun;38(3):1053−1060. doi:10.1016/j. clnu.2018.06.982.
  12. Dindo D, Demartines N, Clavien PA, et al. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205−213. doi:10.1097/01.sla.0000133083.54934.ae.
  13. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010 Dec;113(6):1338−1350. doi:10.1097/ALN.0b013e3181fc6e0a.
  14. Hawn MT, Houston TK, Campagna EJ, et al. The attributable risk of smoking on surgical complications. Ann Surg. 2011;254:914–920. doi:10.1097/ SLA.0b013e31822d7f81.
  15. Musallam KM, Rosendaal FR, Zaatari G, et al. Smoking and the risk of mortality and vascular and respiratory events in patients undergoing major surgery. JAMA Surg. 2013;148:755–762. doi:10.1001/ja-masurg.2013.2360.
  16. Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124:144–154. doi:10.1016/j.amjmed.2010.09.013.
  17. Myers K, Hajek P, Hinds C, et al. Stopping smoking shortly before surgery and postoperative complications: a systematic review and meta-analysis. Arch Intern Med. 2011;171:983–989.  doi:10.1001/archinternmed.2011.97.
  18. Kendall F, Oliveira J, Peleteiro B, et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis. Disabil Rehabil. 2018 Apr;40(8):864−882. doi:10. 1080/09638288.2016.1277396.
  19. He S, Chen B, Li W, et al. Ventilator-associated pneumonia after cardiac surgery: a meta-analysis and systematic review. J Thorac Cardiovasc Surg. 2014;148:3148−155.e3141−145. doi:10.1016/j.jtcvs.2014.07.107.
  1. Ozcaka O, Basoglu OK, Buduneli N, et al. Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: a randomized clinical trial. J Periodontal Res. 2012;47:584−592. doi:10.1111/j.1600-0765.2012.01470.x.
  2. Bardia A, Blitz D, Dai F, et al. Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2019 Oct;158(4):1094−1100. doi:10.1016/j.jtcvs. 2019.01.014.
  3. Carli F, Bousquet-Dion G, Awasthi R, et al. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: randomized clinical trial. JAMA doi:10.1001/jamasurg.2019.5474.
  4. Trepanier M, Minnella EM, Paradis T, et al. Improved disease-free survival after prehabilitation for colorectal cancer surgery. Ann Surg. 2019;270(3):493e501. doi:10.1097/SLA.0000000000003465.
  5. West MA, Astin R, Moyses HE, et al. Exercise prehabilitation may lead to augmented tumor regression following neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Acta Oncol. 2019;58(5):588e595. doi:10.1080/0284186X.2019.1566775.
  6. Gillis C, Buhler K, Bresee L, et al. Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: A systematic review and meta-analysis. Gastroenterology 2018 Aug;155(2):391−410. e4. doi:10.1053/j.gastro.2018.05.012.
  7. West MA, Jack S, Grocott MW, et al. Prehabilitation before surgery: Is it for all patients? Best Pract Res Clin Anaesthesiol. 2021 Dec;35(4):507−516. doi:10.1016/j. bpa.2021.01.001.
  8. Chmelo J, Chmelova I, Phillips AW. Prehabilitation, improving postoperative outcomes. Rozhl Chir. 2021 Fall;100(9):421−428. doi:10.33699/PIS.2021.100.9.421-428.
Labels
Surgery Orthopaedics Trauma surgery
ERAS
Methodology for implementing early recovery after surgery protocols in colorectal surgery
Clinical practice guidelines for perioperative care in bariatric surgery 2023: Adapted ERAS (enhanced recovery after surgery) guidelines with consensual voting of the working group of the Joint Bariatric and Metabolic Surgery Section of the Czech Surgery…
Preoperative nutritional management – compliance with current guidelines
Z 9. světového kongresu společnosti ERAS – Lisabon 2023
Article was published in

Perspectives in Surgery

Issue 7
2023 Issue 7
Most read in this issue
Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#