The association between preoperative physical functioning and short-term postoperative outcomes: a cohort study of patients undergoing elective hepatic resection

Abstract

Background: This study evaluated the association between practical performance-based indices of preoperative physical functioning and short-term postoperative outcomes in patients undergoing hepatic resection.Method: Preoperative characteristics and results of practical performance-based tests of physical functioning were analyzed concerning the effect on postoperative outcomes (recovery of physical functioning, non-surgical complications, and length of hospital stay) using univariable and multivariable logistic regression.Results: Perioperative data of 96 patients showed that besides the conventional risk-factors (American Society of Anesthesiologists grade III and BMI), lower absolute steep ramp test performance (in watts; OR 0.992), and lower perceived level of functional capacity to perform activities of daily living (ADL) on Duke activity status index (in metabolic equivalent of task (MET); OR 0.806) and lower score on the veterans-specific activity questionnaire (in MET, OR 0.875) were associated with delayed recovery of physical functioning. Furthermore, more comorbidities, worse functional mobility, and lower levels of perceived functional capacity to perform ADL were associated with non-surgical complications and length of hospital stay. Conclusion:Adequate preoperative performance and perceived level of functional capacity to perform ADL appear to be of importance to identify individual patients that are at risk of a complicated postoperative course.

Objectively measured preoperative physical activity is associated with time to functional recovery after hepato-pancreato-biliary cancer surgery: a pilot study

“…Furthermore, a higher percentage of predicted distance covered on the ISWT was associated with reduced OR for the occurrence of major postoperative complications found by univariate robust regression. Similar reductions have been reported in multiple studies among a large variety of surgical procedures (Kumar and Garcea 2018;Snowden et al 2010;Simões et al 2018;Van Beijsterveld et al 2019;Levett and Grocott 2015). These reductions might be explained by the higher aerobic reserves enhancing the body's capacity to cope with the responses to the surgical procedure.…”

“…Preoperative aerobic fitness level has been identified as a modifiable risk factor in a variety of patients who need surgery (Snowden et al 2010 ; Simões et al 2018 ; Van Beijsterveld et al 2019 ). A person’s aerobic fitness reflects the physiological reserve available to endure the physical stress of surgery and postoperative recovery (Levett and Grocott 2015 ).…”

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].…”

Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

“…The test consists of a two-minute unloaded warm-up phase, an incremental phase with constant work rate increments of 10 W every 10 seconds (1 W every second), and a three-minute recovery phase. 32 The importance of a maximal effort will be explained clearly to the patient and throughout the test the physical therapist will verbally encourage the patient. During the warm-up and incremental phase, patients will have to maintain a pedaling frequency between 60 and 80 revolutions/min.…”

“…The protocol continues until the patient's pedaling frequency falls definitely <60 revolutions/min, despite strong verbal encouragement. 32 The main outcome of the steep ramp test is the achieved peak work rate (WR peak ). After peak exercise, the patient will be asked to complete a cool-down phase for at least two minutes consisting of unloaded pedaling (0 W) at a frequency of about 40 revolutions/min.…”