Prehabilitation

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Preoperative rehabilitation, prehabilitation or prehab, is a form of healthcare intervention that takes place before a medical or surgical intervention with the aim to reduce side effects and complications, and enhance recovery. [1] [2] Multidisciplinary team involvement can range from physiotherapists, occupational therapists, respiratory therapists, doctors, pharmacologists, anesthesiologists, psychologists, psychiatrists and sports physiologists. [1]

Prehab can be applied to surgical populations in oncology, cardiorespiratory, cardiovascular and orthopaedic settings. The intention is that increasing baseline fitness prior to surgery will allow for relatively higher fitness post-operatively. Prehabilitation interventions are tailored to the patient so that even those with high amounts of comorbidities can receive a positive outcome. Research evidence is mixed, but suggests that prehabilitation reduces hospital stays and therefore risk of hospital acquired infections such as pneumonia. [1]

Prehab is also being considered for use in some cardiovascular interventions, [3] and may also be of some benefit for preventing lung complications, such as pulmonary atelectasis, in general surgery. [4]

Research

In 2013, a pilot study of prehabilitation in colorectal surgery found that it improved postoperative functional recovery, measured in terms of the walking capacity at 4 weeks and 8 weeks (although the time in hospital and post-operative complications were similar). [5]

According to a 2020 study looking at men awaiting surgery for urological cancer, high-intensity interval training (HIIT) may improve heart and lung fitness within a month before their surgery. [6] [7]

Related Research Articles

<span class="mw-page-title-main">Urology</span> Medical specialty

Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs.

<span class="mw-page-title-main">Surgery</span> Medical procedures that involve incisive or invasive instruments into body cavities

Surgery is a medical specialty that uses manual and/or instrumental techniques to physically reach into a subject's body in order to investigate or treat pathological conditions such as a disease or injury, to alter bodily functions, to improve appearance, or to remove/replace unwanted tissues or foreign bodies. The subject receiving the surgery is typically a person, but can also be a non-human animal.

<span class="mw-page-title-main">Laparoscopy</span> Minimally invasive operations within the abdominal or pelvic cavities

Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

<span class="mw-page-title-main">Cardiothoracic surgery</span> Medical specialty involved in surgical treatment of organs inside the thorax

Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart, lungs, and other pleural or mediastinal structures.

Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. Anesthesiologists and surgeons employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available. ASA score is the most well known of these.

<span class="mw-page-title-main">High-intensity interval training</span> Exercise strategy

High-intensity interval training (HIIT) is a training protocol alternating short periods of intense or explosive anaerobic exercise with brief recovery periods until the point of exhaustion. HIIT involves exercises performed in repeated quick bursts at maximum or near maximal effort with periods of rest or low activity between bouts. The very high level of intensity, the interval duration, and number of bouts distinguish it from aerobic (cardiovascular) activity, because the body significantly recruits anaerobic energy systems. The method thereby relies on "the anaerobic energy releasing system almost maximally".

<span class="mw-page-title-main">Cystectomy</span> Surgical removal of all or part of the bladder

Cystectomy is a medical term for surgical removal of all or part of the urinary bladder. It may also be rarely used to refer to the removal of a cyst. The most common condition warranting removal of the urinary bladder is bladder cancer.

<span class="mw-page-title-main">Prostatectomy</span> Surgical removal of all or part of the prostate gland

Prostatectomy is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.

<span class="mw-page-title-main">Pneumonectomy</span> Surgical removal of a lung

A pneumonectomy is a surgical procedure to remove a lung. It was first successfully performed in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung.

<span class="mw-page-title-main">Robot-assisted surgery</span> Surgical procedure

Robot-assisted surgery or robotic surgery are any types of surgical procedures that are performed using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.

<span class="mw-page-title-main">Pelvic exenteration</span> Surgical removal of all pelvic organs

Pelvic exenteration is a radical surgical treatment that removes all organs from a person's pelvic cavity. It is used to treat certain advanced or recurrent cancers. The urinary bladder, urethra, rectum, and anus are removed. In women, the vagina, cervix, uterus, Fallopian tubes, ovaries and, in some cases, the vulva are removed. In men, the prostate is removed. The procedure leaves the person with a permanent colostomy and urinary diversion.

<span class="mw-page-title-main">Adrenalectomy</span> Surgical removal of adrenal glands

Adrenalectomy is the surgical removal of one or both adrenal glands. It is usually done to remove tumors of the adrenal glands that are producing excess hormones or is large in size. Adrenalectomy can also be done to remove a cancerous tumor of the adrenal glands, or cancer that has spread from another location, such as the kidney or lung. Adrenalectomy is not performed on those who have severe coagulopathy or whose heart and lungs are too weak to undergo surgery. The procedure can be performed using an open incision (laparotomy) or minimally invasive laparoscopic or robot-assisted techniques. Minimally invasive techniques are increasingly the gold standard of care due to shorter length of stay in the hospital, lower blood loss, and similar complication rates.

<span class="mw-page-title-main">Mani Menon</span>

Mani Menon, born 9 July 1948 in Trichur, India, is an American surgeon whose work has helped to lay the foundation for modern Robotic Cancer Surgery. He is the founding director and the Raj and Padma Vattikuti Distinguished Chair of the Vattikuti Urology Institute at the Henry Ford Hospital in Detroit, MI, where he established the first cancer-oriented robotics program in the world. Menon is widely regarded for his role in the development of robotic surgery techniques for the treatment of patients with prostate, kidney, and bladder cancers, as well as for the development of robotic kidney transplantation.
Menon is the recipient of the Gold Cystoscope award, Hugh Hampton Young award, the Keyes Medal, the prestigious B.C. Roy award.

In oncology, metastasectomy is the surgical removal of metastases, which are secondary cancerous growths that have spread from cancer originating in another organ in the body.

<span class="mw-page-title-main">Ashutosh Tewari</span> American urologist, oncologist

Ashutosh K. Tewari is the chairman of urology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. He is a board certified American urologist, oncologist, and principal investigator. Before moving to the Icahn School of Medicine in 2013, he was the founding director of both the Center for Prostate Cancer at Weill Cornell Medical College and the LeFrak Center for Robotic Surgery at NewYork–Presbyterian Hospital. Dr. Tewari was the Ronald P. Lynch endowed Chair of Urologic Oncology and the hospital's Director of Robotic Prostatectomy, treating patients with prostate, urinary bladder and other urological cancers. He is the current President of the Society for Urologic Robotic Surgeons (SURS) and the Committee Chair of the Prostate Program. Dr. Tewari is a world leading urological surgeon, and has performed over 10,000 robotically assisted procedures using the da Vinci Surgical System. Academically, he is recognized as a world-renowned expert on urologic oncology with over 250 peer reviewed published papers to his credit; he is on such lists as America's Top Doctors, New York Magazine's Best Doctors, and Who's Who in the World. In 2012, he was given the American Urological Association Gold Cystoscope Award for "outstanding contributions to the field of urologic oncology, most notably the treatment of prostate cancer and the development of novel techniques to improve the outcomes of robotic prostatectomy."

Treatment for prostate cancer may involve active surveillance, surgery, radiation therapy – including brachytherapy and external-beam radiation therapy, proton therapy, high-intensity focused ultrasound (HIFU), cryosurgery, hormonal therapy, chemotherapy, or some combination. Treatments also extend to survivorship based interventions. These interventions are focused on five domains including: physical symptoms, psychological symptoms, surveillance, health promotion and care coordination. However, a published review has found only high levels of evidence for interventions that target physical and psychological symptom management and health promotion, with no reviews of interventions for either care coordination or surveillance. The favored treatment option depends on the stage of the disease, the Gleason score, and the PSA level. Other important factors include the man's age, his general health, and his feelings about potential treatments and their possible side-effects. Because all treatments can have significant side-effects, such as erectile dysfunction and urinary incontinence, treatment discussions often focus on balancing the goals of therapy with the risks of lifestyle alterations.

Interventional oncology is a subspecialty field of interventional radiology that deals with the diagnosis and treatment of cancer and cancer-related problems using targeted minimally invasive procedures performed under image guidance. Interventional oncology has developed to a separate pillar of modern oncology and it employs X-ray, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) to help guide miniaturized instruments to allow targeted and precise treatment of solid tumours located in various organs of the human body, including but not limited to the liver, kidneys, lungs, and bones. Interventional oncology treatments are routinely carried out by interventional radiologists in appropriate settings and facilities.

<span class="mw-page-title-main">Surgery for benign prostatic hyperplasia</span> Type of surgery

If medical treatment is not effective, surgery may need to be performed for benign prostatic hyperplasia.

Cancer rehabilitation has been defined in the scientific literature as a distinct field of medicine that focuses on reducing or eliminating side-effects of cancer treatment and improving survivors' strength, ability to function and quality of life

<span class="mw-page-title-main">Conor P. Delaney</span> Irish-American colorectal surgeon and professor

Conor P. Delaney MD, MCh, PhD, FRCSI, FACS, FASCRS, FRCSI (Hon.) is an Irish-American colorectal surgeon, CEO and President of the Cleveland Clinic Florida, the Robert and Suzanne Tomsich Distinguished Chair in Healthcare Innovation, and Professor of Surgery at the Cleveland Clinic Lerner College of Medicine. He is also the current President of the American Society of Colon and Rectal Surgeons (ASCRS). He was previously Chairman of the Digestive Disease & Surgery Institute at the Cleveland Clinic. He is both a Fellow and Honorary Fellow of the Royal College of Surgeons in Ireland and a Fellow of both the American College of Surgeons and American Society of Colon and Rectal Surgeons.

References

  1. 1 2 3 "Principles and guidance for prehabilitation within the management and support of people with cancer". Macmillan Cancer Support. 30 Nov 2020.
  2. Wynter-Blyth, Venetia; Moorthy, Krishna (2017-08-08). "Prehabilitation: preparing patients for surgery". BMJ. 358: j3702. doi:10.1136/bmj.j3702. ISSN   0959-8138. PMID   28790033. S2CID   29658090.
  3. Alkarmi A, Thijssen DH, Albouaini K, et al. (June 2010). "Arterial prehabilitation: can exercise induce changes in artery size and function that decrease complications of catheterization?". Sports Medicine. 40 (6): 481–92. doi:10.2165/11531950-000000000-00000. PMID   20524713. S2CID   24870534.
  4. Jack S, West M, Grocott MP (September 2011). "Perioperative exercise training in elderly subjects". Best Practice & Research. Clinical Anaesthesiology. 25 (3): 461–72. doi:10.1016/j.bpa.2011.07.003. PMID   21925410.
  5. Li C, Carli F, Lee L, et al. (April 2013). "Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study". Surgical Endoscopy. 27 (4): 1072–82. doi:10.1007/s00464-012-2560-5. PMID   23052535. S2CID   9888085.
  6. "High-intensity interval training rapidly improves fitness in patients awaiting surgery for urological cancer". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 2020-06-05. doi:10.3310/alert_40363. S2CID   242684291.
  7. Blackwell, J. E. M.; Doleman, B.; Boereboom, C. L; Morton, A.; Williams, S.; Atherton, P.; Smith, K.; Williams, J. P.; Phillips, B. E.; Lund, J. N. (10 March 2020). "High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial". Prostate Cancer and Prostatic Diseases. 23 (4): 696–704. doi:10.1038/s41391-020-0219-1. ISSN   1365-7852. PMC   7655502 . PMID   32157250.