Preoperative exercise and prehabilitation

Esser, Tobias; Zimmer, Philipp; Schier, Robert

doi:10.1097/aco.0000000000001188

Cited by 8 publications

(4 citation statements)

References 56 publications

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“…First, the presence of highimpact items can provide targets for prehabilitation. Prehabilitation refers to efforts to improve aspects of the patient's physical and cognitive condition prior to surgery [29], many of which contribute to frailty. While efforts directed toward the lower impact items should not necessarily be ignored, greater reduction in adverse outcomes should be expected by correcting the high-impact indicators.…”

Section: Discussionmentioning

confidence: 99%

A neural network analysis of the effect of high and low frailty index indicators on predicting elective surgery discharge destinations

Walczak¹,

Velanovich

2023

PLoS ONE

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Background Frailty is frequently used by clinicians to help determine surgical outcomes. The frailty index, which represents the frequency of frailty indicators present in an individual, is one method for evaluating patient frailty to predict surgical outcomes. However, the frailty index treats all indicators of frailty that are used in the index as equivalent. Our hypothesis is that frailty indicators may be divided into groups of high and low-impact indicators and this separation will improve surgical discharge outcome prediction accuracy. Data and methods Population data for inpatient elective operations was collected from the 2018 American College of Surgeons National Surgical Quality Improvement Program Participant Use Files. Artificial neural network (ANN) models trained using backpropagation are used to evaluate the relative accuracy for predicting surgical outcome of discharge destination using a traditional modified frailty index (mFI) or a new joint mFI that separates high-impact and low-impact indicators into distinct groups as input variables. Predictions are made across nine possible discharge destinations. A leave-one-out method is used to indicate the relative contribution of high and low-impact variables. Results Except for the surgical specialty of cardiac surgery, the ANN model using distinct high and low-impact mFI indexes uniformly outperformed the ANN models using a single traditional mFI. Prediction accuracy improved from 3.4% to 28.1%. The leave-one-out experiment shows that except for the case of otolaryngology operations, the high-impact index indicators provided more support when determining surgical discharge destination outcomes. Conclusion Frailty indicators are not uniformly similar and should be treated differently in clinical outcome prediction systems.

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Section: Discussionmentioning

confidence: 99%

A neural network analysis of the effect of high and low frailty index indicators on predicting elective surgery discharge destinations

Walczak¹,

Velanovich

2023

PLoS ONE

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“…Die Durchführung einer häuslichen Prähabilitation scheint nur in Einzelfällen realisierbar. Entscheidend sind physiotherapeutische Übungen unter Anleitung, Ernährungsberatung/-therapie, die Indikationsprüfung der Medikamente mit Einstellung einer suffizienten Schmerztherapie, die edukativen Maßnahmen und auch die Aktivierung des sozialen Umfelds [26,27]. Auch könnten Alkohol-und Tabakentwöhnung gebahnt werden.…”

Section: Partizipative Entscheidungsfindungunclassified

Frailty als Herausforderung im klinischen Alltag

Schönenberger¹,

Mörgeli²,

Borchers³

2022

Anästhesiol Intensivmed Notfallmed Schmerzther

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Jeden Tag stehen wir vor neuen Herausforderungendie Betreuung von älteren Menschen mit Frailty-Syndrom gehört dazu. Durch eine gute interdisziplinäre Zusammenarbeit können wir im Sinne der Patienten Lebensqualität erhalten und Morbidität und Mortalität reduzieren. Die Möglichkeiten im perioperativen Setting für Therapie und Begleitung von Patienten mit Frailty-Syndrom werden nachfolgend näher betrachtet. Frailty-Syndrom und Screening Was ist das Frailty-Syndrom? Eine zunehmend älter werdende Bevölkerung bedeutet auch zunehmend ältere Menschen in der klinischen Versorgung. In Deutschland werden pro Jahr ca. 16 Millionen chirurgische Eingriffe durchgeführt, 43 % davon bei Patienten > 65 Jahre [1]. Aber das Alter zeigt uns nur unzu-reichend die individuellen Reserven und komplexen Herausforderungen für die Betreuung von älteren Menschen. Die Beschreibung des Frailty-Syndroms (Gebrechlichkeit) ist der Versuch, das biologische Alter zu erfassen. Es ist gekennzeichnet durch den Verlust von individuellen Reserven, eine erhöhte Anfälligkeit gegenüber internen und externen Stressoren und eine mangelnde Fähigkeit, diese zu kompensieren [6].

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“…A prehabilitation programs can include a variety of physical exercises, nutritional support, and psychological strengthening. Optimization of preoperative clinical conditions contributes to minimize the periprocedural complications and optimization of short-term follow up after surgical procedures [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

How much does it cost to be fit for operation? The economics of prehabilitation

Crişan,

Slankamenac,

Bilotta

2024

Current Opinion in Anaesthesiology

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Purpose of review Prehabilitation before elective surgery can include physical, nutritional, and psychological interventions or a combination of these to allow patients to return postoperatively to baseline status as soon as possible. The purpose of this review is to analyse the current date related to the cost-effectiveness of such programs. Recent findings The current literature regarding the economics of prehabilitation is limited. However, such programs have been mainly associated with either a reduction in total healthcare related costs or no increase. Summary Prehabilitation before elective surgery has been shown to minimize the periprocedural complications and optimization of short term follow up after surgical procedures. Recent studies included cost analysis, either based on hospital accounting data or on estimates costs. The healthcare cost was mainly reduced by shortening the number of hospitalization day. Other factors included length of ICU stay, place of the prehabilitation program (in-hospital vs. home-based) and compliance to the program.

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Preoperative exercise and prehabilitation

Cited by 8 publications

References 56 publications

A neural network analysis of the effect of high and low frailty index indicators on predicting elective surgery discharge destinations

A neural network analysis of the effect of high and low frailty index indicators on predicting elective surgery discharge destinations

Frailty als Herausforderung im klinischen Alltag

How much does it cost to be fit for operation? The economics of prehabilitation

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