Prehabilitation for Hepatopancreatobiliary Surgical Patients: Interim Analysis Demonstrates a Protective Effect From Neoadjuvant Chemotherapy and Improvement in the Frailty Phenotype
| Autor: | Michael D Watson, David A. Iannitti, John B. Martinie, Armida Parala-Metz, Dionisios Vrochides, Erin H. Baker, Vivek Shastry, Maria Baimas-George, Kyle J. Thompson |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Prehabilitation medicine.medical_treatment Psychological intervention Pilot Projects Health Promotion 03 medical and health sciences 0302 clinical medicine Liver Neoplasms Experimental Preoperative Care Medicine Animals Humans 030212 general & internal medicine Prospective Studies Functional decline Intensive care medicine Aged Aged 80 and over Chemotherapy Frailty business.industry Incidence (epidemiology) Carcinoma General Medicine Middle Aged Protective Factors Interim analysis Frailty phenotype Neoadjuvant Therapy Pancreatic Neoplasms Biliary Tract Neoplasms Phenotype Chemotherapy Adjuvant 030220 oncology & carcinogenesis Feasibility Studies Female business Surgical patients |
| Zdroj: | The American surgeon. 87(5) |
| ISSN: | 1555-9823 |
| Popis: | Background Prehabilitation encompasses multidisciplinary interventions to improve health and lessen incidence of surgical deterioration by reducing physiologic stress and functional decline. This study presents an interim analysis to demonstrate prehabilitation for hepatopancreatobiliary (HPB) surgical patients. Methods In 2018, a structured prehabilitation pilot program was implemented. Eligibility required HPB malignancy, neoadjuvant chemotherapy, and residence within hour drive. Patients were enrolled into the 4-month program. The fitness component was composed of timed up and go test and grip strength with exercise recommendations. Nutrition involved evaluation of sarcopenic obesity, glucose management, and smoking and alcohol counseling. Psychological services included psychosocial assessments and advanced care planning, with social work referrals. Component were evaluated monthly by a physician using laboratory results, nutritional data and questionnaires, psychological assessments, and validated fitness tests. Nurse navigators spoke with patients weekly to monitor compliance. Results At 12 months, nineteen patients were enrolled. Ten completed prehabilitation, neoadjuvant chemotherapy and underwent their surgical procedure. There were no differences found after prehabilitation in functional status, physical performance, psychosocial assessments, or nutrition. Frailty, as assessed by Fried frailty criteria, improved significantly after prehabilitation ( P < .0001). Symptom severity and laboratory values did not change. Length of stay was 6.5 days and all patients were discharged to home. There was 1 readmission for transient ischemic attack and 90-day mortality rate was 0%. Discussion Prehabilitation to improve recovery is a promising concept encompassing a wide array of multidisciplinary assessments and interventions. It may demonstrate a protective effect on physiologic decline from chemotherapy and may reverse frailty phenotypes. |
| Databáze: | OpenAIRE |
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