Hao Scarlett, Reis Heidi L, Quinn Ashley W, Snyder Rebecca A, Parikh Alexander A
Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Health Sciences Library, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
J Am Med Dir Assoc. 2022 Apr;23(4):547-554. doi: 10.1016/j.jamda.2022.01.077. Epub 2022 Mar 2.
Morbidity rates following liver resection are high, especially among older adult patients. This review aims to evaluate the evidence surrounding prehabilitation in older patients anticipating liver resection and to describe how prehabilitation may be implemented.
Problem-based narrative review with case-based discussion.
All older adults anticipating liver resection inclusive of benign and malignant etiologies in the United States.
Literature search was performed using MeSH terms and keywords in MEDLINE via PubMed, followed by a manual second search for relevant references within selected articles. Articles were excluded if not available in the English language or did not include patients undergoing hepatectomy.
Prehabilitation includes a range of activities including exercise, nutrition/dietary changes, and psychosocial interventions that may occur from several weeks to days preceding a surgical operation. Older adult patients who participate in prehabilitation may experience improvement in preoperative candidacy as well as improved postoperative quality of life and faster return to baseline; however, evidence supporting a reduction in postoperative length of stay and perioperative morbidity and mortality is conflicting. A variety of modalities are available for prehabilitation but lack consensus and standardization. For a provider desiring to prescribe prehabilitation, multidisciplinary assessments including geriatric, cardiopulmonary, and future remnant liver function can help determine individual patient needs and select appropriate interventions.
In the older adult patient undergoing liver resection, the current body of literature suggests promising benefits of prehabilitation programs inclusive of functional assessment as well as multimodal interventions. Additional research is needed to determine best practices.
肝切除术后的发病率很高，尤其是在老年患者中。本综述旨在评估有关预期进行肝切除的老年患者术前康复的证据，并描述如何实施术前康复。
基于问题的叙述性综述并进行案例讨论。
美国所有预期进行肝切除的老年人，包括良性和恶性病因。
通过PubMed在MEDLINE中使用医学主题词和关键词进行文献检索，随后对选定文章内的相关参考文献进行人工二次检索。如果文章不是英文的或未纳入接受肝切除术的患者，则将其排除。
术前康复包括一系列活动，包括运动、营养/饮食改变以及心理社会干预，这些活动可能在手术前数周或数天进行。参与术前康复的老年患者可能会在术前候选资格方面有所改善，术后生活质量提高，恢复到基线的速度更快；然而，支持缩短术后住院时间以及降低围手术期发病率和死亡率的证据并不一致。有多种术前康复方式可供选择，但缺乏共识和标准化。对于希望开具术前康复处方的医疗服务提供者，包括老年科、心肺科和未来残余肝功能在内的多学科评估有助于确定个体患者的需求并选择合适的干预措施。
在接受肝切除的老年患者中，目前的文献表明，包括功能评估以及多模式干预在内的术前康复计划有望带来益处。需要更多研究来确定最佳实践方法。
