Silver Julie K, Santa Mina Daniel, Bates Andrew, Gillis Chelsia, Silver Emily M, Hunter Tracey L, Jack Sandy
Harvard Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA USA.
Faculty of Kinesiology and Physical Education, The University of Toronto, 55 Harbord St, Toronto, ON M5S 2W6 Canada.
Curr Anesthesiol Rep. 2022;12(1):109-124. doi: 10.1007/s40140-022-00520-6. Epub 2022 Feb 18.
Multimodal prehabilitation aims to improve preoperative health in ways that reduce surgical complications and expedite post-operative recovery. However, the extent to which preoperative health has been affected by the COVID-19 pandemic is unclear and evidence for the mitigating effects of prehabilitation in this context has not been elucidated. The COVID-19 pandemic has forced a rapid reorganization of perioperative pathways. Delayed diagnosis and surgery have caused a backlog of cases awaiting surgery increasing the risk of more complex procedures due to disease progression. Poor fitness and preoperative deconditioning are predictive of surgical complications and may be compounded by pandemic-related restrictions to accessing supportive services. The COVID-19 pandemic has forced a rapid reorganization of perioperative pathways. This narrative review aims to summarize the understanding of the effects of the COVID-19 pandemic on preoperative health and related behaviors and their implication for the need and delivery for prehabilitation to engender improved surgical outcomes. A literature search of Medline was conducted for articles related to preoperative health, prehabilitation, and surgical outcomes published between December 1, 2020 and January 31, 2021. Additional hand searches for relevant publications within the included literature were also conducted through October 15, 2021.
The COVID-19 pandemic, and measures designed to reduce the spread of the virus, have resulted in physical deconditioning, deleterious dietary changes, substance misuse, and heightened anxiety prior to surgery. Due to the adverse health changes prior to surgery, and often protracted waiting time for surgery, there is likely an elevated risk of peri- and post-operative complications. A small number of prehabilitation services and research programmes have been rapidly adapted or implemented to address these needs.
During the COVID-19 pandemic to date, people undergoing surgery have faced a triple threat posed by extended wait times for surgery, reduced access to supportive services, and an elevated risk of poor outcomes. It is imperative that healthcare providers find ways to employ evidence-based prehabilitation strategies that are accessible and safe to mitigate the negative impact of the pandemic on surgical outcomes. Attention should be paid to cohorts most affected by established health inequities and further exacerbated by the pandemic.
多模式术前康复旨在通过减少手术并发症和加快术后恢复来改善术前健康状况。然而，目前尚不清楚COVID-19大流行对术前健康的影响程度，且在此背景下术前康复减轻影响的证据也未得到阐明。COVID-19大流行迫使围手术期路径迅速重新组织。诊断和手术延迟导致了等待手术的病例积压，由于疾病进展，更复杂手术的风险增加。身体状况不佳和术前失健是手术并发症的预测因素，而与大流行相关的获得支持性服务的限制可能会使情况更加复杂。COVID-19大流行迫使围手术期路径迅速重新组织。本叙述性综述旨在总结对COVID-19大流行对术前健康和相关行为的影响及其对术前康复需求和实施的影响的理解，以提高手术效果。对2020年12月1日至2021年1月31日期间发表的与术前健康、术前康复和手术结果相关的文章进行了Medline文献检索。截至2021年10月15日，还对纳入文献中的相关出版物进行了额外的手工检索。
COVID-19大流行以及为减少病毒传播而采取的措施导致了身体失健、有害的饮食变化、药物滥用以及术前焦虑加剧。由于手术前的健康状况恶化以及通常较长的手术等待时间，围手术期和术后并发症的风险可能会升高。少数术前康复服务和研究项目已迅速调整或实施以满足这些需求。
在迄今为止的COVID-19大流行期间，接受手术的患者面临着手术等待时间延长、获得支持性服务的机会减少以及不良结局风险升高这三大威胁。医疗保健提供者必须找到方法，采用可及且安全的循证术前康复策略，以减轻大流行对手术结果的负面影响。应关注受既定健康不平等影响最大且因大流行而进一步加剧的人群。
