Department of Anaesthesia, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
Department of Anaesthesia, Hutt Valley District Health Board, Newtown, New Zealand.
BMJ Open Qual. 2023 May;12(2). doi: 10.1136/bmjoq-2022-002064.
Prehabilitation has been shown to improve outcomes for patients undergoing major surgery; benefits include reductions in length of hospital stay and postoperative complications. Multimodal prehabilitation programmes lead to improved patient engagement and experience. This report describes implementation of a personalised multimodal prehabilitation programme for patients awaiting colorectal cancer surgery. We aim to highlight the successes, challenges and future direction of our programme.Patients listed for colorectal cancer surgery were referred for initial prehabilitation assessment. The prehabilitation group were assessed by specialist physiotherapists, dieticians and psychologists. An individualised programme was developed for each patient, aiming to optimise preoperative functional capacity and enhance physical and psychological resilience. Clinical primary outcome measures were recorded and compared with contemporaneous controls. For those undergoing prehabilitation, a set of secondary functional, nutritional and psychological outcomes were recorded at initial assessment and on completion of the programme.61 patients were enrolled in the programme from December 2021 to October 2022. 12 patients were excluded as they received less than 14 days prehabilitation or had incomplete data. The remaining 49 patients received a median duration of 24 days prehabilitation (range 15-91 days). The results show statistically significant improvements in the following functional outcome measures after prehabilitation: Rockwood scores, maximal inspiratory pressures, International Physical Activity Questionnaire Score and Functional Assessment of Chronic Illness - Fatigue Score. There was a lower postoperative complication rate in the prehabilitation group when compared with a control group (50% vs 67%).This quality improvement project has 3 Plan-Do-Study-Act (PDSA) cycles. PDSA 1 demonstrates prehabilitation can be successfully imbedded within a colorectal surgical unit and that patients are grateful for the service. PDSA 2 provides the project's first complete data set and demonstrates functional improvements in patients undergoing prehabilitation. The third PDSA cycle is ongoing and aims to refine the prehabilitation interventions and improve clinical outcomes for patients undergoing colorectal cancer surgery.
预康复已被证明可以改善接受大手术的患者的预后；其益处包括住院时间和术后并发症的减少。多模式预康复计划可提高患者的参与度和体验。本报告描述了为接受结直肠癌手术的患者实施个性化多模式预康复计划的情况。我们旨在强调我们计划的成功、挑战和未来方向。
接受结直肠癌手术的患者被转介进行初始预康复评估。预康复组由专科物理治疗师、营养师和心理学家进行评估。为每位患者制定了个性化计划，旨在优化术前功能能力，增强身体和心理弹性。记录临床主要结局测量值，并与同期对照组进行比较。对于接受预康复的患者，在初始评估和完成计划时记录一组次要功能、营养和心理结局。
2021 年 12 月至 2022 年 10 月期间，共有 61 名患者参加了该计划。12 名患者因接受预康复不足 14 天或数据不完整而被排除。其余 49 名患者接受了中位数为 24 天的预康复（范围 15-91 天）。结果显示，预康复后以下功能结局测量值有统计学显著改善：Rockwood 评分、最大吸气压力、国际体力活动问卷评分和慢性疾病疲劳量表评分。与对照组相比，预康复组的术后并发症发生率较低（50%比 67%）。
该质量改进项目有 3 个计划-执行-研究-行动（PDSA）循环。PDSA1 表明预康复可以成功地嵌入结直肠外科病房，并且患者对该服务表示感激。PDSA2 提供了项目的第一个完整数据集，并表明接受预康复的患者的功能得到了改善。第三个 PDSA 循环正在进行中，旨在改进预康复干预措施，并改善接受结直肠癌手术的患者的临床结局。
