A toolbox for a structured risk-based prehabilitation program in major surgical oncology

Frontiers in Surgery

Surgery

Katharina Beyer¹  Svenja Sliwinski²  Patrizia Malkomes²  Elisabeth Werneburg²  Charlotte Detemble²  Wolf O. Bechstein²  Sara Fatima Faqar-Uz-Zaman²  Andreas A. Schnitzbauer³  Dora Zmuc⁴  Tim Vilz⁵  Christoph Reissfelder⁶  Joerg P. Ritz⁷  Florian Herrle⁸  Lisa Mohr⁹  Julia Dreilich⁹  Johannes Fleckenstein^1,10 

[1] Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany;German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany;Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany;Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany;German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany;Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany;Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany;German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany;Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany;German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany;Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany;Helios Clinics Schwerin, Department for General and Visceral Surgery, Schwerin, Germany;German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany;Romed Klinik Prien am Chiemsee, Klinik für Allgemein- und Viszeralchirurgie, Prien am Chiemsee, Germany;Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany;Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany;Department of Pain Medicine, Hospital Landsberg am Lech, Landsberg am Lech, Germany;

关键词: surgical oncology;    prehabilitation;    morbidity;    risk assessment—methods;    exercising;    nutrition;    mental wellbeing;    PBM;   

DOI  :  10.3389/fsurg.2023.1186971

 received in 2023-03-15, accepted in 2023-04-17,  发布年份 2023

来源: Frontiers

【 摘 要 】

Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients’ resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in outcomes and definitions. In this scoping review, class 1 and 2 evidence was included to identify seven main aspects of prehabilitation for the treatment pathway: (i) risk assessment, (ii) FITT (frequency, interventions, time, type of exercise) principles of prehabilitation exercise, (iii) outcome measures, (iv) nutrition, (v) patient blood management, (vi) mental wellbeing, and (vii) economic potential. Recommendations include the risk of tumor progression due to delay of surgery. Patients undergoing prehabilitation should perceive risk assessment by structured, quantifiable, and validated tools like Risk Analysis Index, Charlson Comorbidity Index (CCI), American Society of Anesthesiology Score, or Eastern Co-operative Oncology Group scoring. Assessments should be repeated to quantify its effects. The most common types of exercise include breathing exercises and moderate- to high-intensity interval protocols. The program should have a duration of 3–6 weeks with 3–4 exercises per week that take 30–60 min. The 6-Minute Walking Testing is a valid and resource-saving tool to assess changes in aerobic capacity. Long-term assessment should include standardized outcome measurements (overall survival, 90-day survival, Dindo–Clavien/CCI®) to monitor the potential of up to 50% less morbidity. Finally, individual cost-revenue assessment can help assess health economics, confirming the hypothetic saving of $8 for treatment for $1 spent for prehabilitation. These recommendations should serve as a toolbox to generate hypotheses, discussion, and systematic approaches to develop clinical prehabilitation standards.

【 授权许可】

Unknown   
© 2023 Sliwinski, Werneburg, Faqar-Uz-Zaman, Detemble, Dreilich, Mohr, Zmuc, Beyer, Bechstein, Herrle, Malkomes, Reissfelder, Ritz, Vilz, Fleckenstein and Schnitzbauer.