Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy.
Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy.
Nutrients. 2024 Jun 6;16(11):1783. doi: 10.3390/nu16111783.
Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.
大约 15-50%的克罗恩病 (CD) 患者在诊断后十年内需要手术。手术前管理可改变的危险因素对于减少术后并发症和促进更好的术后恢复至关重要。术前营养不良、功能能力降低、肌肉减少症、免疫抑制药物、贫血和心理困扰在 CD 患者中经常出现。多模式术前康复包括术前实施的营养、功能、医疗和心理干预,旨在优化术前状态并改善术后恢复。目前,尚无研究评估多模式术前康复对 CD 患者术后结局的影响。一些研究调查了单一术前康复干预的效果,其中营养优化是研究最多的。本综述的目的是阐述支持 CD 患者手术前多模式手术前康复的生理学依据,并描述其主要组成部分,以促进其在术前常规护理中的应用。
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