Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strateg...Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strategies for such surgeries. Methods: A total of 33 TKA recipients (45 knees) in our department underwent repair of unilateral or bilateral tibial defects using the cement-screw technique. The subjects were divided into two groups based on the differences in preoperative interventions. The control group received routine preoperative health education according to the consensus, while the observation group received instructive and standardized prehabilitation exercises for four weeks in addition to the routine education. Scale scores, intraoperative parameters, and postoperative recovery indicators were recorded at different time pointsand subjected to statistical analysis for intra-group and inter-group differences. All subjects underwent long-term follow-up for at least 24 months. Results: Within each group at different time points, there were statistically significant differences in VAS, ROM, and HSS scores (p Conclusions: Cement-screw technique for repairing tibial plateau bone defects in TKA recipients can significantly relieve pain, and improve joint function. Prehabilitation can improve preoperative rehabilitation reserves in these patients, accelerate postoperative recovery, and contribute to better short-term clinical outcomes.展开更多
Patients with Crohn’s disease(CD)are at a considerable risk for intestinal surgery.Approximately 25%of patients with CD will undergo an intestinal resection within 10 years of diagnosis.Postoperative complications af...Patients with Crohn’s disease(CD)are at a considerable risk for intestinal surgery.Approximately 25%of patients with CD will undergo an intestinal resection within 10 years of diagnosis.Postoperative complications after CD surgery have been reported in 20%-47%of the patients.Both general and CD-related risk factors are associated with postoperative complications,and comprise non-modifiable(e.g.,age)and potentially modifiable risk factors(e.g.,malnutrition).Prehabilitation focuses on the preoperative period with strategies designed to optimize modifiable risk factors concerning the physical and mental condition of the individual patient.The aim of prehabilitation is to enhance postoperative recovery and return to or even improve preoperative functional capacity.Preoperative improvement of nutritional status,physical fitness,cessation of smoking,psychological support,and critical revision of preoperative use of CD medication are important strategies.Studies of the effect on postoperative outcome in CD patients are scarce,and guidelines lack recommendations on tailored management.In this opinion review,we review the current evidence on the impact of screening and management of nutritional status,physical fitness,CD medication and laboratory values on the postoperative course following an intestinal resection in CD patients.In addition,we aim to provide guidance for individualized multimodal prehabilitation in clinical practice concerning these modifiable factors.展开更多
A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes.These included an increased risk of to...A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes.These included an increased risk of total complications,major complications,re-admissions,infections,severe infections,30 d mortality,longer hospital stay and increased hospitalization expenditures.A program to enhance recovery after surgery was meant to address these complications;however,compliance to the program since its introduction has been less than ideal.Over the last decade,the concept of prehabilitation,or"pre-surgery rehabilitation",has been discussed.The presurgical period represents a window of opportunity to boost and optimize the health of an individual,providing a compensatory"buffer"for the imminent reduction in physiological reserve postsurgery.Initial results have been promising.We review the literature to critically review the utility of prehabilitation,not just in the clinical realm,but also in the scientific realm,with a resource management point-of-view.展开更多
Background Surgery may be the field of healthcare where malnutrition and sarcopenia have their greatest impact on patient morbidity and mortality.However,there are limited data on the nutritional status of surgical pa...Background Surgery may be the field of healthcare where malnutrition and sarcopenia have their greatest impact on patient morbidity and mortality.However,there are limited data on the nutritional status of surgical patients and the effects of prehabilitation on the outcomes of surgery.Methods A prospective analysis was conducted on all patients surgically-treated for malignant gastrointestinal tumors at St.John Hospital during a two-year period.The patient’s gender,age,body weight,height,BMI and weight loss were registered,then a risk score was determined by the MUST survey.Measurement of the triceps and thigh skin-fold thickness and the circumference of the upper arm and thigh were done to calculate muscle area and muscle index,respectively.The body composition was assessed using an OMRON-BF511 device.Muscle function was evaluated based on hand clamping force measurement and activity tests.Patients who were diagnosed as being at-risk received preoperative prehabilitation,which included physiotherapy and nutritional therapy.Results A total of 231 patients(133 males/98 females)were analyzed.They had a mean age of 68.9 years(18~98).Seventy-four patients(32%)lost weight,with an average loss of 7 kilograms(3~15 kg).Anthropometric data showed an average upper-arm circumference of 27.4 cm(14.3~38.1)and thigh circumference of 44.7 cm(19.3~60.1),so the median muscle index was 1.29.The mean BMI was 26,which is above normal,and the elevated BMI was consistent documented in each patient subgroup stratified by age and tumor type.A body composition analysis was performed for 75 patients(44 male/31 female),who had a median age of 68(37~88 y).The average BMI of these patients was 25.7 y and their average MUST score was 1.12.The total body fat percentage(of the total body mass)was 29.5%,total muscle was 30.1%and visceral fat was 10%.Thirty patients(40%)had sarcopenia,with a mean BMI of 28.7,fat comprising 34.2%of the body mass,visceral-fat 11%,and muscle 27.1%,and their median MUST score was 1.23.Patients who received preoperative training(physiotherapy)showed improvements in physical function ranging from 12%~33%.Conclusion Gastrointestinal tumor patients have a higher than normal BMI regardless of age or tumor type.Patients with sarcopenia show measurable improvement after two weeks of prehabilitation.展开更多
Background:Hepato-pancreatico-biliary(HPB)patients experience significant risk of preoperative frailty.Studies assessing preventative prehabilitation in HPB populations are limited.This systematic review and meta-anal...Background:Hepato-pancreatico-biliary(HPB)patients experience significant risk of preoperative frailty.Studies assessing preventative prehabilitation in HPB populations are limited.This systematic review and meta-analysis evaluates outcomes for HPB patients treated with exercise prehabilitation.Data sources:A comprehensive search of MEDLINE(via Ovid),Embase(Ovid),Scopus,Web of Science Core Collection,Cochrane Library(Wiley),Pro Quest Dissertations,Theses Global,and Google Scholar was conducted with review and extraction following PRISMA guidelines.Included studies evaluated more than 5 adult HPB patients undergoing≥7-day exercise prehabilitation.The primary outcome was postoperative length of stay(LOS);secondary outcomes included complications,mortality,physical performance,and quality of life.Results:We evaluated 1778 titles and abstracts and selected 6(randomized controlled trial,n=3;prospective cohort,n=1;retrospective cohort,n=2)that included 957 patients.Of those,536 patients(56.0%)underwent exercise prehabilitation and 421(44.0%)received standard care.Patients in both groups were similar with regards to important demographic factors.Prehabilitation was associated with a 5.20-day LOS reduction(P=0.03);when outliers were removed,LOS reduction decreased to 1.85 days and was non-statistically significant(P=0.34).Postoperative complications(OR=0.70;95%CI:0.39 to 1.26;P=0.23),major complications(OR=0.83;95%CI:0.60 to 1.14;P=0.24),and mortality(OR=0.67;95%CI:0.17 to 2.70;P=0.57)were similar.Prehabilitation was associated with improved strength,cardiopulmonary function,quality of life,and alleviated sarcopenia.Conclusions:Exercise prehabilitation may reduce LOS and morbidity following HPB surgery.Studies with well-defined exercise regimens are needed to optimize exercise prehabilitation outcomes.展开更多
Bariatric surgery offers the best health results in overweight and obese patients but is not a risk and/or complication-free treatment.In cases with additional hyperglycemia,the burden of surgery can be even higher an...Bariatric surgery offers the best health results in overweight and obese patients but is not a risk and/or complication-free treatment.In cases with additional hyperglycemia,the burden of surgery can be even higher and alter both shortterm and long-term outcomes.Although bariatric surgery offers glycemic improvements and in the case of early onset diabetes disease remission,weight loss results are lower than for obese patients without diabetes.Different multimodal programs,usually including interventions related to patients’performance,nutritional and psychological status as well as currently available pharmacotherapy before the surgery itself might considerably improve the immediate and late postoperative course.However,there are still no clear guidelines addressing the prehabilitation of obese patients with dysglycemia undergoing bariatric surgery and therefore no unique protocols to improve patients’health.In this minireview,we summarize the current knowledge on prehabilitation before bariatric surgery procedures in patients with obesity and dysglycemia.展开更多
Patients affected by pancreatic ductal adenocarcinoma(PDAC)frequently present with advanced disease at the time of diagnosis,limiting an upfront surgical approach.Neoadjuvant treatment(NAT)has become the standard of c...Patients affected by pancreatic ductal adenocarcinoma(PDAC)frequently present with advanced disease at the time of diagnosis,limiting an upfront surgical approach.Neoadjuvant treatment(NAT)has become the standard of care to downstage non-metastatic locally advanced PDAC.However,this treatment increases the risk of a nutritional status decline,which in turn,may impact therapeutic tolerance,postoperative outcomes,or even prevent the possibility of surgery.Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications,length of hospital stay,and readmission rate,while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing.Particularly,appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma.In this regard,NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program,aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival outcomes.Given these perspectives,this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.展开更多
Ageing population of first world economies pose unique challenges to surgical community.Enhanced recovery after surgery protocols and pathways do not attempt to optimize or enhance physical function of patients by cus...Ageing population of first world economies pose unique challenges to surgical community.Enhanced recovery after surgery protocols and pathways do not attempt to optimize or enhance physical function of patients by customized program of physical activity.Increasingly,prehabilitation programs(PP)have gained momentum in orthopaedics,urology,colorectal surgery and hepatopancreaticobiliary surgery.Current evidence of PP in various elective surgical procedures have shown improved outcomes with minimal to none drawback or harm.There is emerging evidence of role of PP in elective liver resection.The aim of this paper is to review the basis of PP and share local multidisciplinary team protocol specifically customized to frail and elderly population-Recovery Of Surgery in Elderly.展开更多
Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical complications.It includes interventions that optimize nutrition,glycemic control,functional sta...Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical complications.It includes interventions that optimize nutrition,glycemic control,functional status,and utilization of the patient's microbiome pre-,intra-,and postoperatively.Through a multidisciplinary and anticipatory approach to patients'existing co-morbidities,the physiological stress of surgery may be attenuated to ultimately minimize perioperative morbidity in the elective setting.With increasing data to support the efficacy of prehabilitation in optimizing surgical outcomes and decreasing hospital length of stay,it is incumbent on the surgeon to employ these practices in elective abdominal wall reconstruction.Further research on the effects of prehabilitation interventions will help to shape and inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best practices in surgical care.展开更多
Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been prov...Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol,leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery,rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes,described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS,e.g.,the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better,more reliable patient outcomes.展开更多
Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biom...Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),Wanfang Database,and VIP Database were searched to obtain the relevant literature involving enhanced recovery after surgery(ERAS)guidance,obtain the effective clinical data,review the reports in literature,and obtain the effective scheme.Results:Compared with the traditional nursing program,perioperative nursing principles guided by the concept of ERAS provide more accurate nursing care to patients and reduce the occurrence of intraoperative stress events through comprehensive nursing measures such as preoperative pre-rehabilitation measures,intraoperative body temperature and fluid management,postoperative analgesia,prevention of nausea and vomiting,early mobilization,catheter nursing,and better out-of-hospital follow-up.Conclusions:Perioperative nursing principles guided by the concept of ERAS can significantly reduce the incidence of perioperative complications,shorten the hospital stay of patients,and promote postoperative rehabilitation of patients.The transformation and implementation of this concept can bring significant benefits to hospitals,medical care,and patients.展开更多
The era of geriatric surgery has arrived with increased global life expectancy.The need to optimize outcomes in this group of patients goes beyond traditional outcomes such as postoperative morbidity and mortality ind...The era of geriatric surgery has arrived with increased global life expectancy.The need to optimize outcomes in this group of patients goes beyond traditional outcomes such as postoperative morbidity and mortality indicators.Recognizing risk factors that impact adverse surgical outcomes such as frailty and sarcopenia,individualizing optimization strategies such as prehabilitation and a multidisciplinary geriatric surgical service have been shown to improve postoperative outcomes and help the older surgical patient regain premorbid function and maintain quality of life.There needs to be a concerted effort to increase awareness of this increasingly important topic in practicing surgeons around the world to meet the challenges of the aging population.展开更多
Twenty-three recommendations were summarized by the Enhanced Recovery After Surgery(ERAS)society for liver surgery.The aim was to validate the protocol especially with regard to adherence and the impact on morbidity.M...Twenty-three recommendations were summarized by the Enhanced Recovery After Surgery(ERAS)society for liver surgery.The aim was to validate the protocol especially with regard to adherence and the impact on morbidity.Methods:Using the ERAS Interactive Audit System(EIAS),ERAS items were evaluated in patients undergoing liver resection.Over a period of 26 months,304 patients were prospectively enrolled in an observational study(DRKS00017229).Of those,51 patients(non-ERAS)were enrolled before and 253 patients(ERAS)after the implementation of the ERAS protocol.Perioperative adherence and complications were compared between the two groups.Results:Overall adherence increased from 45.2%in the non-ERAS group to 62.7%in the ERAS group(P<0.001).This was associated with significant improvements in the preoperative and postoperative phase(P<0.001),rather than in the outpatient and intraoperative phase(both P>0.05).Overall complications decreased from 41.2%(n=21)in the non-ERAS group to 26.5%(n=67)in the ERAS group(P=0.0423),which was mainly due to the reduction of grade 1-2 complications from 17.6%(n=9)to 7.6%(n=19)(P=0.0322).As for patients undergoing open surgery,implementation of ERAS lead to a reduction of overall complications in patients scheduled for minimally invasive liver surgery(MILS)(P=0.036).Conclusions:Implementation of the ERAS protocol for liver surgery according to the ERAS guidelines of the ERAS Society reduced Clavien-Dindo grade 1-2 complications particularly in patients who underwent MILS.The ERAS guidelines are beneficial for the outcome,while adherence to the various items has not yet been satisfactorily defined.展开更多
文摘Objective: To investigate the clinical efficacy of the cement-screw technique in repairing tibial plateau bone defects in total knee arthroplasty (TKA) recipients and summarize the preoperative prehabilitation strategies for such surgeries. Methods: A total of 33 TKA recipients (45 knees) in our department underwent repair of unilateral or bilateral tibial defects using the cement-screw technique. The subjects were divided into two groups based on the differences in preoperative interventions. The control group received routine preoperative health education according to the consensus, while the observation group received instructive and standardized prehabilitation exercises for four weeks in addition to the routine education. Scale scores, intraoperative parameters, and postoperative recovery indicators were recorded at different time pointsand subjected to statistical analysis for intra-group and inter-group differences. All subjects underwent long-term follow-up for at least 24 months. Results: Within each group at different time points, there were statistically significant differences in VAS, ROM, and HSS scores (p Conclusions: Cement-screw technique for repairing tibial plateau bone defects in TKA recipients can significantly relieve pain, and improve joint function. Prehabilitation can improve preoperative rehabilitation reserves in these patients, accelerate postoperative recovery, and contribute to better short-term clinical outcomes.
文摘Patients with Crohn’s disease(CD)are at a considerable risk for intestinal surgery.Approximately 25%of patients with CD will undergo an intestinal resection within 10 years of diagnosis.Postoperative complications after CD surgery have been reported in 20%-47%of the patients.Both general and CD-related risk factors are associated with postoperative complications,and comprise non-modifiable(e.g.,age)and potentially modifiable risk factors(e.g.,malnutrition).Prehabilitation focuses on the preoperative period with strategies designed to optimize modifiable risk factors concerning the physical and mental condition of the individual patient.The aim of prehabilitation is to enhance postoperative recovery and return to or even improve preoperative functional capacity.Preoperative improvement of nutritional status,physical fitness,cessation of smoking,psychological support,and critical revision of preoperative use of CD medication are important strategies.Studies of the effect on postoperative outcome in CD patients are scarce,and guidelines lack recommendations on tailored management.In this opinion review,we review the current evidence on the impact of screening and management of nutritional status,physical fitness,CD medication and laboratory values on the postoperative course following an intestinal resection in CD patients.In addition,we aim to provide guidance for individualized multimodal prehabilitation in clinical practice concerning these modifiable factors.
文摘A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes.These included an increased risk of total complications,major complications,re-admissions,infections,severe infections,30 d mortality,longer hospital stay and increased hospitalization expenditures.A program to enhance recovery after surgery was meant to address these complications;however,compliance to the program since its introduction has been less than ideal.Over the last decade,the concept of prehabilitation,or"pre-surgery rehabilitation",has been discussed.The presurgical period represents a window of opportunity to boost and optimize the health of an individual,providing a compensatory"buffer"for the imminent reduction in physiological reserve postsurgery.Initial results have been promising.We review the literature to critically review the utility of prehabilitation,not just in the clinical realm,but also in the scientific realm,with a resource management point-of-view.
文摘Background Surgery may be the field of healthcare where malnutrition and sarcopenia have their greatest impact on patient morbidity and mortality.However,there are limited data on the nutritional status of surgical patients and the effects of prehabilitation on the outcomes of surgery.Methods A prospective analysis was conducted on all patients surgically-treated for malignant gastrointestinal tumors at St.John Hospital during a two-year period.The patient’s gender,age,body weight,height,BMI and weight loss were registered,then a risk score was determined by the MUST survey.Measurement of the triceps and thigh skin-fold thickness and the circumference of the upper arm and thigh were done to calculate muscle area and muscle index,respectively.The body composition was assessed using an OMRON-BF511 device.Muscle function was evaluated based on hand clamping force measurement and activity tests.Patients who were diagnosed as being at-risk received preoperative prehabilitation,which included physiotherapy and nutritional therapy.Results A total of 231 patients(133 males/98 females)were analyzed.They had a mean age of 68.9 years(18~98).Seventy-four patients(32%)lost weight,with an average loss of 7 kilograms(3~15 kg).Anthropometric data showed an average upper-arm circumference of 27.4 cm(14.3~38.1)and thigh circumference of 44.7 cm(19.3~60.1),so the median muscle index was 1.29.The mean BMI was 26,which is above normal,and the elevated BMI was consistent documented in each patient subgroup stratified by age and tumor type.A body composition analysis was performed for 75 patients(44 male/31 female),who had a median age of 68(37~88 y).The average BMI of these patients was 25.7 y and their average MUST score was 1.12.The total body fat percentage(of the total body mass)was 29.5%,total muscle was 30.1%and visceral fat was 10%.Thirty patients(40%)had sarcopenia,with a mean BMI of 28.7,fat comprising 34.2%of the body mass,visceral-fat 11%,and muscle 27.1%,and their median MUST score was 1.23.Patients who received preoperative training(physiotherapy)showed improvements in physical function ranging from 12%~33%.Conclusion Gastrointestinal tumor patients have a higher than normal BMI regardless of age or tumor type.Patients with sarcopenia show measurable improvement after two weeks of prehabilitation.
文摘Background:Hepato-pancreatico-biliary(HPB)patients experience significant risk of preoperative frailty.Studies assessing preventative prehabilitation in HPB populations are limited.This systematic review and meta-analysis evaluates outcomes for HPB patients treated with exercise prehabilitation.Data sources:A comprehensive search of MEDLINE(via Ovid),Embase(Ovid),Scopus,Web of Science Core Collection,Cochrane Library(Wiley),Pro Quest Dissertations,Theses Global,and Google Scholar was conducted with review and extraction following PRISMA guidelines.Included studies evaluated more than 5 adult HPB patients undergoing≥7-day exercise prehabilitation.The primary outcome was postoperative length of stay(LOS);secondary outcomes included complications,mortality,physical performance,and quality of life.Results:We evaluated 1778 titles and abstracts and selected 6(randomized controlled trial,n=3;prospective cohort,n=1;retrospective cohort,n=2)that included 957 patients.Of those,536 patients(56.0%)underwent exercise prehabilitation and 421(44.0%)received standard care.Patients in both groups were similar with regards to important demographic factors.Prehabilitation was associated with a 5.20-day LOS reduction(P=0.03);when outliers were removed,LOS reduction decreased to 1.85 days and was non-statistically significant(P=0.34).Postoperative complications(OR=0.70;95%CI:0.39 to 1.26;P=0.23),major complications(OR=0.83;95%CI:0.60 to 1.14;P=0.24),and mortality(OR=0.67;95%CI:0.17 to 2.70;P=0.57)were similar.Prehabilitation was associated with improved strength,cardiopulmonary function,quality of life,and alleviated sarcopenia.Conclusions:Exercise prehabilitation may reduce LOS and morbidity following HPB surgery.Studies with well-defined exercise regimens are needed to optimize exercise prehabilitation outcomes.
文摘Bariatric surgery offers the best health results in overweight and obese patients but is not a risk and/or complication-free treatment.In cases with additional hyperglycemia,the burden of surgery can be even higher and alter both shortterm and long-term outcomes.Although bariatric surgery offers glycemic improvements and in the case of early onset diabetes disease remission,weight loss results are lower than for obese patients without diabetes.Different multimodal programs,usually including interventions related to patients’performance,nutritional and psychological status as well as currently available pharmacotherapy before the surgery itself might considerably improve the immediate and late postoperative course.However,there are still no clear guidelines addressing the prehabilitation of obese patients with dysglycemia undergoing bariatric surgery and therefore no unique protocols to improve patients’health.In this minireview,we summarize the current knowledge on prehabilitation before bariatric surgery procedures in patients with obesity and dysglycemia.
文摘Patients affected by pancreatic ductal adenocarcinoma(PDAC)frequently present with advanced disease at the time of diagnosis,limiting an upfront surgical approach.Neoadjuvant treatment(NAT)has become the standard of care to downstage non-metastatic locally advanced PDAC.However,this treatment increases the risk of a nutritional status decline,which in turn,may impact therapeutic tolerance,postoperative outcomes,or even prevent the possibility of surgery.Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications,length of hospital stay,and readmission rate,while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing.Particularly,appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma.In this regard,NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program,aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival outcomes.Given these perspectives,this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.
文摘Ageing population of first world economies pose unique challenges to surgical community.Enhanced recovery after surgery protocols and pathways do not attempt to optimize or enhance physical function of patients by customized program of physical activity.Increasingly,prehabilitation programs(PP)have gained momentum in orthopaedics,urology,colorectal surgery and hepatopancreaticobiliary surgery.Current evidence of PP in various elective surgical procedures have shown improved outcomes with minimal to none drawback or harm.There is emerging evidence of role of PP in elective liver resection.The aim of this paper is to review the basis of PP and share local multidisciplinary team protocol specifically customized to frail and elderly population-Recovery Of Surgery in Elderly.
文摘Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical complications.It includes interventions that optimize nutrition,glycemic control,functional status,and utilization of the patient's microbiome pre-,intra-,and postoperatively.Through a multidisciplinary and anticipatory approach to patients'existing co-morbidities,the physiological stress of surgery may be attenuated to ultimately minimize perioperative morbidity in the elective setting.With increasing data to support the efficacy of prehabilitation in optimizing surgical outcomes and decreasing hospital length of stay,it is incumbent on the surgeon to employ these practices in elective abdominal wall reconstruction.Further research on the effects of prehabilitation interventions will help to shape and inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best practices in surgical care.
文摘Since the concept of enhanced recovery after surgery(ERAS)was introduced in the late 1990 s the idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol,leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery,rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes,described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS,e.g.,the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better,more reliable patient outcomes.
基金supported by Emerging industry leading talent project of Shanxi Province(No.[2020]587)。
文摘Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),Wanfang Database,and VIP Database were searched to obtain the relevant literature involving enhanced recovery after surgery(ERAS)guidance,obtain the effective clinical data,review the reports in literature,and obtain the effective scheme.Results:Compared with the traditional nursing program,perioperative nursing principles guided by the concept of ERAS provide more accurate nursing care to patients and reduce the occurrence of intraoperative stress events through comprehensive nursing measures such as preoperative pre-rehabilitation measures,intraoperative body temperature and fluid management,postoperative analgesia,prevention of nausea and vomiting,early mobilization,catheter nursing,and better out-of-hospital follow-up.Conclusions:Perioperative nursing principles guided by the concept of ERAS can significantly reduce the incidence of perioperative complications,shorten the hospital stay of patients,and promote postoperative rehabilitation of patients.The transformation and implementation of this concept can bring significant benefits to hospitals,medical care,and patients.
文摘The era of geriatric surgery has arrived with increased global life expectancy.The need to optimize outcomes in this group of patients goes beyond traditional outcomes such as postoperative morbidity and mortality indicators.Recognizing risk factors that impact adverse surgical outcomes such as frailty and sarcopenia,individualizing optimization strategies such as prehabilitation and a multidisciplinary geriatric surgical service have been shown to improve postoperative outcomes and help the older surgical patient regain premorbid function and maintain quality of life.There needs to be a concerted effort to increase awareness of this increasingly important topic in practicing surgeons around the world to meet the challenges of the aging population.
文摘Twenty-three recommendations were summarized by the Enhanced Recovery After Surgery(ERAS)society for liver surgery.The aim was to validate the protocol especially with regard to adherence and the impact on morbidity.Methods:Using the ERAS Interactive Audit System(EIAS),ERAS items were evaluated in patients undergoing liver resection.Over a period of 26 months,304 patients were prospectively enrolled in an observational study(DRKS00017229).Of those,51 patients(non-ERAS)were enrolled before and 253 patients(ERAS)after the implementation of the ERAS protocol.Perioperative adherence and complications were compared between the two groups.Results:Overall adherence increased from 45.2%in the non-ERAS group to 62.7%in the ERAS group(P<0.001).This was associated with significant improvements in the preoperative and postoperative phase(P<0.001),rather than in the outpatient and intraoperative phase(both P>0.05).Overall complications decreased from 41.2%(n=21)in the non-ERAS group to 26.5%(n=67)in the ERAS group(P=0.0423),which was mainly due to the reduction of grade 1-2 complications from 17.6%(n=9)to 7.6%(n=19)(P=0.0322).As for patients undergoing open surgery,implementation of ERAS lead to a reduction of overall complications in patients scheduled for minimally invasive liver surgery(MILS)(P=0.036).Conclusions:Implementation of the ERAS protocol for liver surgery according to the ERAS guidelines of the ERAS Society reduced Clavien-Dindo grade 1-2 complications particularly in patients who underwent MILS.The ERAS guidelines are beneficial for the outcome,while adherence to the various items has not yet been satisfactorily defined.
