Ramírez-Martín Raquel, Mauleón Ladrero Coro, Gazo Martínez Jose Antonio, Déniz-González Victoria, Martín Maestre Isabel, Corral-Sastre Lucía, Villajos-Guijarro María, Menéndez-Colino Rocío, Pascual Miguelañez Isabel, González-Montalvo Juan Ignacio
Department of Geriatric, Hospital Universitario La Paz, 28046 Madrid, Spain.
Hospital La Paz Institute for Health Research-IdiPAZ, Hospital Universitario La Paz-Universidad Autónoma de Madrid, 28046 Madrid, Spain.
J Clin Med. 2024 Oct 14;13(20):6114. doi: 10.3390/jcm13206114.
There is still limited evidence on the results of prehabilitation in very old frail patients. The aim of this study is to analyze the outcomes and course of octogenarian and nonagenarian patients undergoing prehabilitation before surgery for colorectal cancer (CRC). : a prospective study was conducted in a tertiary hospital from 2018 to 2022. All patients diagnosed with CRC over 80 years old and proposed for surgery were included. A comprehensive geriatric assessment (CGA) for frailty detection was performed, and the therapeutic decision was taken by the multidisciplinary tumor committee. Prehabilitation led by the geriatric team was performed. The rate of medical and surgical complications, hospital stay, in-hospital mortality, and first-year mortality were recorded. : CRC surgery was proposed in 184 patients >80 years. After a multidisciplinary decision, surgery was performed on 126 (68.5%) patients, of whom 12 (0.5%) were nonagenarians. Fifty percent of octogenarians and 86% of nonagenarians were frail. Prehabilitation consisted of the following: adapted physical exercise (100%); oral nutritional supplementation (73.8%); anemia treatment (59.5%); delirium prevention (5.6%); antidepressant treatment (15.9%); vitamin D supplementation (21.4%); and pharmacological deprescription (38.1%). The post-surgical complication rate was low (4.3% surgical and 29.4% medical complications), and in-hospital mortality was very low (3.2%). Nonagenarian patients had a higher rate of complications compared to octogenarians (OR 4.0 (95% CI 1.13-14.12))-mainly heart failure (OR 4.68 (95% CI 1.21-18.09))-but there were no differences in hospital stay or first-year mortality. : prehabilitation in very old patients with CRC surgery is possible and provides good results.
关于高龄体弱患者术前康复的结果，目前证据仍然有限。本研究的目的是分析八旬和九旬结直肠癌（CRC）患者术前康复的结果及病程。：2018年至2022年在一家三级医院进行了一项前瞻性研究。纳入所有80岁以上诊断为CRC且拟行手术的患者。进行了全面的老年综合评估（CGA）以检测虚弱情况，治疗决策由多学科肿瘤委员会做出。由老年团队主导进行术前康复。记录医疗和手术并发症发生率、住院时间、院内死亡率和第一年死亡率。：184例80岁以上患者被建议行CRC手术。经过多学科决策，126例（68.5%）患者接受了手术，其中12例（0.5%）为九旬老人。50%的八旬老人和86%的九旬老人体弱。术前康复包括以下内容：适应性体育锻炼（100%）；口服营养补充（73.8%）；贫血治疗（59.5%）；谵妄预防（5.6%）；抗抑郁治疗（15.9%）；维生素D补充（21.4%）；以及药物调整（38.1%）。术后并发症发生率较低（手术并发症4.3%，医疗并发症29.4%），院内死亡率非常低（3.2%）。与八旬老人相比，九旬老人并发症发生率更高（比值比4.0（95%置信区间1.13 - 14.12）），主要是心力衰竭（比值比4.68（95%置信区间1.21 - 18.09）），但住院时间或第一年死亡率无差异。：高龄CRC手术患者进行术前康复是可行的，且效果良好。
