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

IF 3.4 3区 医学 Q1 ANESTHESIOLOGY
Ian M Randall, Darren Au, Daniel Sibley, Andrew G Matthew, Maggie Chen, Priya Brahmbhatt, Calvin Mach, Daniel Sellers, Shabbir M H Alibhai, Hance Clarke, Gail Darling, Stuart A McCluskey, Laura McKinney, Karen Ng, Fayez Quereshy, Keyvan Karkouti, Daniel Santa Mina
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引用次数: 0

Abstract

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.

启动外科手术预康复计划:一项实用性非随机可行性研究的结果。
目的:我们试图评估作为外科辅助服务实施的多模式康复前服务的可行性,并估计其对疗效的影响:我们进行了一项关于手术前康复的实用性非随机可行性研究。患者年龄≥18岁,英语流利,并由医疗专业人员转介,即可接受康复治疗。参与者接受个性化的术前运动、营养、心理和/或戒烟支持计划。主要结果是操作可行性,包括转诊量、注册率、术前康复窗口期、参与度、完成率和安全性。次要结果包括手术并发症、住院时间、再入院率、生活质量以及身心健康。定性数据涉及干预的可行性和可接受性。我们将干预参与者与转诊但拒绝接受预康复治疗的患者进行了比较:116名患者被转介接受康复前治疗。转诊患者的平均年龄为 71 岁,55% 为男性。超过 90% 的转诊患者来自肿瘤外科,最常见的转诊指征是体弱(46%)。在 116 名转诊患者中,83 人同意参与研究。从基线到手术前,患者报告的结果和客观测量的结果均有显著改善,术后 90 天恢复到手术前水平。定性研究结果表明,术前康复干预深受欢迎:结论:多模式手术术前康复作为一种综合临床服务是可行的,并能有效改善生理和心理结果。需要进一步评估加拿大的临床综合康复计划,以证实这些研究结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.50
自引率
7.10%
发文量
161
审稿时长
6-12 weeks
期刊介绍: The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.
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