Kulinski Kasia, Smith Natalie A
Department of Anaesthesia, Prince of Wales Hospital, Randwick, Australia.
Department of Anaesthesia, Wollongong Hospital, Wollongong, Australia.
Anaesth Intensive Care. 2020 Sep;48(5):373-380. doi: 10.1177/0310057X20947731. Epub 2020 Oct 8.
Many patients spend months waiting for elective procedures, and many have significant modifiable risk factors that could contribute to an increased risk of perioperative morbidity and mortality. The minimal direct contact that usually occurs with healthcare professionals during this period represents a missed opportunity to improve patient health and surgical outcomes. Patients with obesity comprise a large proportion of the surgical workload but are under-represented in prehabilitation studies. Our study piloted a mobile phone based, multidisciplinary, prehabilitation programme for patients with obesity awaiting elective surgery. A total of 22 participants were recruited via the Wollongong Hospital pre-admissions clinic in New South Wales, Australia, and 18 completed the study. All received the study intervention of four text messages per week for six months. Questionnaires addressing the self-reported outcome measures were performed at the start and completion of the study. Forty percent of participants lost weight and 40% of smokers decreased their cigarette intake over the study. Sixty percent reported an overall improved health score. Over 80% of patients found the programme effective for themselves, and all recommended that it be made available to other patients. The cost was A$1.20 per patient per month. Our study showed improvement in some of the risk factors for perioperative morbidity and mortality. With improved methods to increase enrolment, our overall impression is that text message-based mobile health prehabilitation may be a feasible, cost-effective and worthwhile intervention for patients with obesity.
许多患者要花费数月等待择期手术，而且很多患者有显著的可改变风险因素，这些因素可能导致围手术期发病率和死亡率增加。在此期间，患者与医护人员之间通常的直接接触极少，这是改善患者健康和手术结局的一个错失的机会。肥胖患者占手术工作量的很大比例，但在术前康复研究中的代表性不足。我们的研究为等待择期手术的肥胖患者试点了一项基于手机的多学科术前康复计划。通过澳大利亚新南威尔士州卧龙岗医院的预入院诊所招募了22名参与者，其中18人完成了研究。所有参与者在六个月内每周收到四条短信的研究干预。在研究开始和结束时进行了针对自我报告结局指标的问卷调查。在研究期间，40%的参与者体重减轻，40%的吸烟者减少了香烟摄入量。60%的参与者报告总体健康评分有所改善。超过80%的患者认为该计划对自己有效，并且所有人都建议将其提供给其他患者。成本为每位患者每月1.20澳元。我们的研究表明围手术期发病率和死亡率的一些风险因素有所改善。随着增加招募人数的方法得到改进，我们的总体印象是，基于短信的移动健康术前康复可能是一种对肥胖患者可行、具有成本效益且值得的干预措施。
