Exploring the relation between preoperative physical functioning and the impact of major complications in patients following pancreatic resection

Abstract

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Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial

“…Although prehabilitation cannot prevent all complications, the impact of a postoperative complication might also be reduced in patients with a higher physical fitness, 12,30 as previously indicated in coronary artery bypass graft surgery and pancreatic surgery. 31,32 Barberan-Garcia and colleagues 17 reported that prehabilitation before elective major abdominal surgery significantly improved preoperative aerobic fitness and significantly reduced the number of high-risk patients with postoperative complications (RR 0.5, 95% CI 0.3-0.8), as compared to usual care. However, they selected highrisk patients based on age, ASA score, and Duke activity status index score and not on formal (cardiopulmonary) exercise testing.…”

“…Moreover, Barberan-Garcia et al 17 found an overall incidence of complications of 46% in high-risk patients (age >70 years, ASA score III/IV, and Duke activity status index score ≤46) undergoing major abdominal surgery. Although prehabilitation cannot prevent all complications, the impact of a postoperative complication might also be reduced in patients with a higher physical fitness, 12,30 as previously indicated in coronary artery bypass graft surgery and pancreatic surgery 31,32 …”

Enhanced recovery after surgery programmes in older patients undergoing hepatopancreatobiliary surgery: what benefits might prehabilitation have?

“…When performing a preoperative CPET is not possible, more practical performance-based field tests to estimate a patient's preoperative aerobic fitness might be useful for risk assessment. Better performance at the steep ramp test, a short time maximal exercise test on a cycle ergometer, has been found to be associated with more favourable postoperative outcomes and may be valuable in outcome prediction in patients undergoing HPB surgery [49,50]. Moreover, an increased distance walked at the 6-min walk test was related to a reduced risk of major postoperative complications in surgery for HPB malignancies; patients that walked <400 m had a considerably higher Clavien-Dindo grade than patients who walked 400 m [51].…”

“…Being fit for surgery might not always prevent postoperative complications; however, the impact of any given postoperative complication may be reduced in patients with a higher preoperative physical fitness. A small study in patients undergoing pancreatic resection demonstrated that those who were younger and those with a higher preoperative physical fitness were more likely to better cope with a major postoperative complication [49]. Investing in adequate prehabilitation programs therefore seems an effective way to improve surgical outcomes by reducing preoperative risks and, consequently, both the incidence and the impact of postoperative complications.…”

Steep ramp test protocol for preoperative risk assessment and short‐term high‐intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology

“…The SRT WR peak is equal to 148% of the CPET WR peak , while the peripheral muscle strength is the predominant limitation of SRT performance. Previous studies reported that preoperative SRT (1 W/s) performance (WR peak , W/kg) is inversely associated with the risk of adverse postoperative outcomes after hepatic, 18 pancreatic, 19 and colorectal resection. 20,21 However, a test-specific cutoff and multivariate predictive model including the SRT performance that can be used to classify patients at low versus high risk for adverse surgical outcomes are lacking; therefore, further research is required.…”