‘Start to finish trans‐institutional transdisciplinary care’: a novel approach improves colorectal surgical results in frail elderly patients

Chia, C. K.; Mantoo, Surendra Kumar; Tan, Kok‐Yang

doi:10.1111/codi.13166

Cited by 87 publications

(140 citation statements)

References 28 publications

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“…This hypothesis is strengthened by the study of Chia et al . , who recently published the results of a multimodal programme that observed a reduction in the length of hospital stay after multimodal prehabilitation. Third, older patients require a tailor‐made approach to the execution of a trial.…”

Section: Discussionmentioning

confidence: 99%

The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review

et al. 2016

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Section: Discussionmentioning

confidence: 99%

The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review

et al. 2016

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“…Second, this study focused specifically on preoperative treatment of anemia. However, investigation and treatment of merely Hb levels appears to be a suboptimal way to indicate overall performance and therefore, at present, various multimodal programs are being introduced . The use of such various modalities could be valuable in preoperative prehabilitation, specifically in elderly patients (>75 years), in which an increased 1‐year mortality of up to 25% is observed .…”

Section: Discussionmentioning

confidence: 99%

“…However, investigation and treatment of merely Hb levels appears to be a suboptimal way to indicate overall performance and therefore, at present, various multimodal programs are being introduced. 30,31 The use of such various modalities could be valuable in preoperative prehabilitation, specifically in elderly patients (>75 years), in which an increased 1-year mortality of up to 25% is observed. 32,33 In line with the previous limitation, in this study, various multimodal programs may similarly introduce confounding of our results that are not easily corrected for.…”

Section: Discussionmentioning

confidence: 99%

Short‐term effect of preoperative intravenous iron therapy in colorectal cancer patients with anemia: results of a cohort study

et al. 2017

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“…Similarly patients undergoing prehabilitation had no difference in surgical outcomes compared to those undergoing post-operative rehabilitation [27,28]. A single study has shown that prehabilitation improves hospital lengths of stay without effecting complications for colorectal surgery patients [29]. …”

Section: Discussionmentioning

confidence: 99%

Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

Reddy¹,

Singletary²,

Bradford³

et al. 2016

Journal of the American College of Surgeons

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Background Current methods to predict patients' peri-operative morbidity utilize complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the present study is to determine the value of a timed stair climb (SC) in predicting peri-operative complications for patients undergoing abdominal surgery. Study Design From March 2014 to July 2015, 362 patients attempted SC while being timed prior to undergoing elective abdominal surgery. Vital signs were measured before and after SC. Ninety day post-operative complications were assessed by the Accordion Severity Grading System. The prognostic value of SC was compared to the ACS NSQIP risk calculator. Results A total of 264 (97.4%) patients were able to complete SC. SC time directly correlated to changes in both mean arterial pressure and heart rate as an indicator of stress. An Accordion grade 2 or higher complication occurred in 84 (25%) patients. There were 8 mortalities (2.4%). Patients with slower SC times had an increased complication rate (P<0.0001). In multivariable analysis SC time was the single strongest predictor of complications (OR=1.029, P<0.0001), and no other clinical co-morbidity reached statistical significance. Receiver operative characteristic curves predicting post-operative morbidity by SC time was superior to that of the ACS risk calculator (AUC 0.81 vs. 0.62, P<0.0001). Additionally slower patients had a greater deviation from predicted length of hospital stay (P=0.034) Conclusions SC provides measurable stress, accurately predicts post-operative complications, and is easy to administer in patients undergoing abdominal surgery. Larger patient populations with a diverse group of operations will be needed to further validate the use of SC in risk prediction models.

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‘Start to finish trans‐institutional transdisciplinary care’: a novel approach improves colorectal surgical results in frail elderly patients

Abstract: Through a trans-institutional transdisciplinary approach, we managed to achieve a significantly shorter hospital stay in frail patients having colorectal surgery. All elective patients who received prehabilitation achieved full functional recovery.

Cited by 87 publications

References 28 publications

The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review

The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review

Short‐term effect of preoperative intravenous iron therapy in colorectal cancer patients with anemia: results of a cohort study

Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

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