Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Division of Internal Medicine, Department of Hospice and Palliative Medicine, Carolinas Medical Center, Charlotte, NC, USA.
World J Surg. 2020 Nov;44(11):3668-3678. doi: 10.1007/s00268-020-05658-0.
Frailty is a customized marker of biological age that helps to gauge an individual's functional physiologic reserve and ability to react to stress and is associated with increased postoperative morbidity and mortality. In order to mitigate frailty preoperatively, the concept of prehabilitation has entered the forefront which encompasses multidisciplinary interventions to improve health and lessen the incidence of postoperative decline. The purpose of this study is to investigate the impact of prehabilitation on postoperative outcomes in frail, surgical patients.
A comprehensive literature search was performed by two independent researchers according to PRISMA guidelines. Inclusion criteria were (1) a randomized controlled trial, case-control or observational study; (2) prehabilitation intervention; (3) frailty assessment; and (4) surgical intervention.
There were five articles included in the review. Evaluation of these articles demonstrated prehabilitation may improve operative outcomes in frail surgical patients. There were no assessments as to whether prehabilitation was cost-effective although it was feasible. Prehabilitation programs should include elements of exercise, nutrition, and psychosocial counseling. Frailty should be assessed with a validated index in surgical patients who may undergo prehabilitation.
Prehabilitation in frail surgical patients may be the appropriate process through which providers can lessen operative risk. Currently, however, there is little evidence supporting the use of prehabilitation in this population with only five studies identified in this systematic review. More randomized controlled trials are clearly needed.
衰弱是一种定制的生物年龄标志物，可以帮助评估个体的功能生理储备和应对压力的能力，与术后发病率和死亡率增加有关。为了术前减轻衰弱，预康复的概念已经成为主流，它包括多学科干预措施，以改善健康状况并减少术后下降的发生率。本研究旨在探讨预康复对衰弱手术患者术后结局的影响。
两名独立研究人员根据 PRISMA 指南进行了全面的文献检索。纳入标准为：(1)随机对照试验、病例对照或观察性研究；(2)预康复干预；(3)衰弱评估；(4)手术干预。
综述共纳入 5 篇文章。对这些文章的评估表明，预康复可能改善衰弱手术患者的手术结局。虽然预康复是可行的，但没有评估其是否具有成本效益。预康复计划应包括运动、营养和社会心理咨询等要素。在可能接受预康复的手术患者中，应使用经过验证的指数评估衰弱。
预康复可能是衰弱手术患者减轻手术风险的适当方法。然而，目前只有五项研究在本系统评价中确定，支持在这一人群中使用预康复的证据很少。显然需要更多的随机对照试验。
