Prehab, ERAS, Rehab: A patient care continuum around colo-rectal surgery: Prehabilitation combined with ERAS and rehabilitation to reduce morbidity and hospital stay.

Autor: Gonella F; SC. Chirurgia Generale, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: fgonella@mauriziano.it., Massucco P; SC. Chirurgia Generale, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: pmassucco@mauriziano.it., Perotti S; SC. Chirurgia Generale, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: sperotti@mauriziano.it., Gianolio S; SC. Chirurgia Generale, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: sgianolio@mauriziano.it., Vassallo D; S.S. Dietologia e Nutrizione Clinica, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: dvassallo@mauriziano.it., Monasterolo S; S.C. Recupero e Riabilitazione, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: smonasterolo@mauriziano.it., Laezza A; S.S.D Psicologia, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: alaezza@mauriziano.it., De Zolt Ponte B; SC. Chirurgia Generale, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: b.dezoltponte@gmail.com., Ricotti A; Sperimentazioni e Comitato Etico, 'Clinical Trial Unit', Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: aricotti@mauriziano.it., Ferrero A; SC. Chirurgia Generale, Ospedale Mauriziano 'Umberto I', Largo Turati 62, Torino, Italy. Electronic address: aferrero@mauriziano.it.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2024 Sep 12; Vol. 50 (12), pp. 108688. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1016/j.ejso.2024.108688
Abstrakt: Background: Prehabilitation (Prehab) programs aim to optimize patients psycho-physical condition before surgery, to improve post-operative outcomes. Although functional benefits of Prehab are known, the clinical impact does not yet have concrete evidence. The objective of this study is to evaluate the efficacy of Prehab, associated with Enhanced Recovery After Surgery (ERAS) and surgical rehabilitation (Rehab), in frail colorectal oncological patients in terms of morbidity and hospitalization.
Patients and Methods: The cohort of patients undergoing Prehab between January 2020 and December 2022 (Prehab group) is compared with the historical cohort of patients operated on in the period 01/2018-12/2019, not undergoing Prehab (no-Prehab group). Prehab scheme: multimodal (physiotherapy, clinical nutrition and psychological support). All patients followed an ERAS path. Only Prehab patients followed a surgical Rehab by a dedicated nurse case-manager. Propensity score matching (PSM) and weighting (PSW) analyses were used for statistical analysis.
Primary Objectives: complications at 30 days and hospital stay.
Secondary Objectives: functional outcomes.
Results: In 3 years of preliminary enrollment, 36 patients completed the program: 22 in person, 16 in tele-prehab. The Prehab group experienced fewer complications than the no-Prehab group (PSM: 31 % vs 53 % p = 0.02; PSW: 31 % vs 51 % p = 0.02), less severe complications (CCI>20 PSM: 17 % vs 33 % p = 0.074; PSW: 17 % vs 53 % 0.026) and shorter hospital stay (4.5 vs 6 days; p = 0.02). Finally, prehabilitated patients improved their preoperative functional capacity and reduced anxiety levels.
Conclusion: The strategy of combining Prehab with ERAS and Rehab has positively influenced post-operative clinical outcomes as well as functional parameters in our series.
(Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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