Prehabilitation in Thoracic Cancer Surgery: From Research to Standard of Care.
J Cardiothorac Vasc Anesth
; 35(11): 3255-3264, 2021 11.
Article
en En
| MEDLINE
| ID: mdl-33752968
ABSTRACT
OBJECTIVE:
To determine whether personalized, stepped prehabilitation care is a feasible, safe, and effective implementation strategy.DESIGN:
Quality improvement project. Data collected prospectively from August 2018 to December 2019 were analyzed retrospectively to describe the clinical implementation of a prehabilitation care program for elective lung cancer surgery.SETTING:
Single center, tertiary university hospital.PARTICIPANTS:
Eighty-one consecutive adult patients living in the metropolitan area of Montreal were included if an elective resection of suspected or confirmed lung cancer was planned.INTERVENTIONS:
At the earliest contemplation of surgery, the whole cohort was screened for impaired physical, nutritional, and/or psychological status. Patients screened at higher risk received dedicated assessment and personalized prehabilitation care upon specific needs. MEASUREMENTS AND MAINRESULTS:
Patients' specific needs and their access and flow through the different services were described. Prehabilitation effectiveness was evaluated using walking and exercise tests, and adverse events were monitored. Eighty-one patients were screened for functional impairments. Forty patients showed reduction of physical function, seven of them refused the specific assessment, one refused in-hospital exercise; 48 patients showed nutritional risk, eight of them refused or did not comply with nutritional therapy. Overall, 45 high-risk patients received a one-month personalized prehabilitation program 16 partook in a trimodal program (exercise, nutrition, and psychological), and 22 received a program with both nutrition and exercise. No adverse events occurred during the study period. After prehabilitation, six-minute waking distance improved by 29.9 meters (standard deviation 47.3 m) (nâ¯=â¯35; pâ¯=â¯0.001) and the oxygen uptake at the anaerobic threshold improved by 1.6 (1.7) mL/kg/min (nâ¯=â¯13; pâ¯=â¯0.004). Length of hospital stay was two (interquartile range one-four) days in prehabilitated patients versus three (two-seven) days in the usual care group (pâ¯=â¯0.101).CONCLUSIONS:
A personalized, stepped prehabilitation program targeting high-risk patients undergoing elective lung cancer surgery was feasible, safe, and effective.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Ejercicio Preoperatorio
/
Neoplasias Pulmonares
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Adult
/
Humans
Idioma:
En
Revista:
J Cardiothorac Vasc Anesth
Asunto de la revista:
ANESTESIOLOGIA
/
CARDIOLOGIA
Año:
2021
Tipo del documento:
Article