Starting a surgical prehabilitation program: results from a pragmatic nonrandomized feasibility study.

Autor: Randall IM; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada. ian.randall@uhn.ca.; Faculty of Medicine, University of Toronto, Toronto, ON, Canada. ian.randall@uhn.ca., Au D; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada., Sibley D; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada., Matthew AG; Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada., Chen M; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada., Brahmbhatt P; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada., Mach C; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada., Sellers D; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.; Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Alibhai SMH; Department of Medicine, University Health Network, Toronto, ON, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada., Clarke H; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.; Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Darling G; Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada., McCluskey SA; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.; Faculty of Medicine, University of Toronto, Toronto, ON, Canada., McKinney L; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada., Ng K; Department of Geriatrics, Sinai Health System, Toronto, ON, Canada., Quereshy F; Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada., Karkouti K; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.; Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Santa Mina D; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada. daniel.santamina@uhn.ca.; Faculty of Medicine, University of Toronto, Toronto, ON, Canada. daniel.santamina@uhn.ca.; Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord St., Toronto, ON, M5S 2W6, Canada. daniel.santamina@uhn.ca.
Jazyk: angličtina
Zdroj: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2024 Nov 06. Date of Electronic Publication: 2024 Nov 06.
DOI: 10.1007/s12630-024-02861-8
Abstrakt: Purpose: We sought to assess the feasibility and estimate the effects on outcomes of a multimodal prehabilitation service implemented as an ancillary surgical service.
Methods: We conducted a pragmatic, nonrandomized feasibility study of surgical prehabilitation. Patients were eligible if they were ≥ 18 yr of age, fluent in English, and referred by a health professional for prehabilitation. Participants received an individualized program of preoperative exercise, nutrition, psychological, and/or smoking cessation support. The primary outcome was operational feasibility, including referral volume, enrolment rate, prehabilitation window, engagement, completion rate, and safety. Secondary outcomes included surgical complications, length of hospital stay, readmission, quality of life, and physical and mental health. Qualitative data related to intervention feasibility and acceptability. We compared intervention participants with patients who were referred for, but declined, prehabilitation.
Results: One hundred and sixteen patients were referred for prehabilitation. The mean age of referred patients was 71 yr and 55% were male. Over 90% of referrals were from surgical oncology, and the most common indication for referral was frailty (46%). Of the 116 referred patients, 83 consented to participate in the study. Patient-reported and objectively measured outcomes improved by a clinically important margin from baseline to presurgery, and returned to presurgery levels by 90 days postoperatively. Qualitative findings suggest that the prehabilitation intervention was well received.
Conclusion: Multimodal surgical prehabilitation is feasible as an integrated clinical service and may be effective for improving physical and psychological outcomes. Further evaluations of clinically integrated prehabilitation programs in Canada are needed to confirm these findings.
(© 2024. Canadian Anesthesiologists' Society.)
Databáze: MEDLINE
Externí odkaz: