School of Medicine, Stanford University, Stanford, California.
Department of Surgery, Stanford University, Stanford, California.
J Surg Res. 2022 May;273:226-232. doi: 10.1016/j.jss.2021.12.023. Epub 2022 Jan 29.
Preoperative optimization programs have demonstrated positive effects on perioperative physical function and surgical outcomes. In nonsurgical populations, physical activity and healthy diet may reduce pain and pain medication requirement, but this has not been studied in surgical patients. Our aim was to determine whether a preoperative diet and exercise intervention affects postoperative pain and pain medication use.
Patients undergoing abdominal colorectal surgery were invited to participate in a web-based patient engagement program. Those enrolling in the first and third time periods received information on the standard perioperative pathway (enhanced recovery after surgery [ERAS]). Those enrolling in the second time period also received reminders on nutrition and exercise (PREHAB + ERAS). The primary outcome was postoperative inpatient opioid use. The secondary outcomes were inpatient postoperative pain scores and nonopioid pain medication use.
The ERAS and PREHAB + ERAS groups were similar in demographic and operative characteristics. Subgroup analysis of patients who activated their accounts demonstrated that the two groups had similar average maximum daily pain scores, but the PREHAB + ERAS group (n = 158) used 15.9 fewer oral morphine equivalents per postoperative inpatient day than the ERAS group (n = 92), representing a 30% decrease (53 mg versus 37.1 mg, P = 0.04). The two groups used comparable amounts of acetaminophen, gabapentin, and ketorolac. Generalized linear models demonstrated that PREHAB + ERAS, minimally invasive surgery, and older age were associated with lower inpatient opioid use.
Access to a web-based preoperative diet and exercise program may reduce inpatient opioid use after major elective colorectal surgery. Further studies are necessary to determine whether the degree of adherence to nutrition and physical activity recommendations has a dose-dependent effect on opioid use.
术前优化方案已证明对围手术期身体功能和手术结果有积极影响。在非手术人群中，身体活动和健康饮食可能会减轻疼痛和减少止痛药物的需求，但尚未在手术患者中进行研究。我们的目的是确定术前饮食和运动干预是否会影响术后疼痛和止痛药物的使用。
邀请接受腹部结直肠手术的患者参加基于网络的患者参与计划。在前两个时间段内注册的患者收到了有关标准围手术期途径（加速康复外科 [ERAS]）的信息。在第三个时间段内注册的患者还收到了关于营养和运动的提醒（PREHAB+ERAS）。主要结局是术后住院期间阿片类药物的使用。次要结局是住院期间术后疼痛评分和非阿片类止痛药物的使用。
ERAS 和 PREHAB+ERAS 组在人口统计学和手术特征方面相似。对激活其账户的患者进行亚组分析表明，两组的平均最大每日疼痛评分相似，但 PREHAB+ERAS 组（n=158）在术后住院期间每天使用的口服吗啡等效物减少了 15.9 个，减少了 30%（53mg 比 37.1mg，P=0.04）。两组使用的对乙酰氨基酚、加巴喷丁和酮咯酸的量相当。广义线性模型表明，PREHAB+ERAS、微创手术和年龄较大与住院期间阿片类药物使用减少相关。
访问基于网络的术前饮食和运动计划可能会减少择期结直肠手术后的住院期间阿片类药物的使用。需要进一步的研究来确定对营养和身体活动建议的依从程度是否对阿片类药物的使用有剂量依赖性影响。
