The key questions in rehabilitation in thoracic surgery

Mahendran, Kajan; Naidu, Babu

doi:10.21037/jtd.2018.03.147

Cited by 14 publications

(19 citation statements)

References 63 publications

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“…This personal belief can be counterintuitive, as thoracic surgeons use the exercise capacity as an element to determine a patients' fitness for surgery. The risk factors for postoperative complications have a higher prevalence amongst the lung cancer patients and prehabilitation can be used to modify most of them, thus improving outcomes [16].…”

Section: Not Sure 4%mentioning

confidence: 99%

National survey of enhanced recovery after thoracic surgery practice in the United Kingdom and Ireland

Budacan

Mehdi

Kerr

et al. 2020

J Cardiothorac Surg

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Background Evidence that Enhanced Recovery After Thoracic Surgery (ERAS) improves clinical outcomes is growing. Following the recent publications of the international ERAS guidelines in Thoracic surgery, the aim of this audit was to capture variation and perceived difficulties to ERAS implementation, thus helping its development at a national level. Methods We designed an anonymous online survey and distributed it via email to all 36 centres that perform lung lobectomy surgery in the UK and Ireland. It included 38 closed, open and multiple-choice questions on the core elements of ERAS and took an average of 10 min to complete. Results Eighty-two healthcare professionals from 34 out of 36 centres completed the survey; majority were completed by consultant thoracic surgeons (57%). Smoking cessation support varied and only 37% of individuals implemented the recommended period for fluid fasting; 59% screen patients for malnutrition and 60% do not give preoperative carbohydrate loading. The compliance with nerve sparing techniques when a thoracotomy is performed was poor (22%). 66% of respondents apply suction on intercostal drains and although 91% refer all lobectomies for physiotherapeutic assessment, the physiotherapy adjuncts varied across centres. Perceived barriers to implementation were staffing levels, lack of teamwork/consistency, limited resources over weekend and the reduced access to smoking cessation services. Conclusion Centres across the UK are working to develop the ERAS pathway. This survey aids this process by providing insight into “real life” ERAS, increasing exposure of staff to the ESTS- ERAS recommendations and identifying barriers to implementation.

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Section: Not Sure 4%mentioning

confidence: 99%

National survey of enhanced recovery after thoracic surgery practice in the United Kingdom and Ireland

Budacan

Mehdi

Kerr

et al. 2020

J Cardiothorac Surg

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“…The term prehabilitation refers to preoperative physical conditioning intended to enhance the patient’s capacity to withstand the stress of surgery and promote postoperative recovery (Batchelor et al 2019 ). Studies in patients undergoing pulmonary resection for lung cancer have shown that prehabilitation regimens improve measures of lung function such as FEV 1 , forced vital capacity, and performance in the 6-min walk test (Cavalheri and Granger 2017 ; Morano et al 2013 ; Sebio Garcia et al 2016 ; Ni et al 2017 ; Pouwels et al 2015 ; Vagvolgyi et al 2017 ), and hence prehabilitation is now recommended in guidelines for a variety of thoracic surgery procedures (Batchelor et al 2019 ; Mahendran and Naidu 2018 ; Tew et al 2018 ). There is also evidence that prehabilitation is associated with lower rates of postoperative pulmonary complications, and shorter hospital stays, in patients undergoing resection for lung cancer (Cavalheri and Granger 2017 ; Sebio Garcia et al 2016 ; Ni et al 2017 ; Pouwels et al 2015 ; Benzo et al 2011 ; Boujibar et al 2018 ; Steffens et al 2018 ).…”

Section: Preadmission Carementioning

confidence: 99%

“…In addition to exercise, prehabilitation regimens in thoracic surgery patients may also encompass other interventions, such as optimizing concomitant medical conditions and nutritional status and smoking cessation (Mahendran and Naidu 2018 ). One study in patients undergoing resection for lung cancer has investigated the efficacy of a prehabilitation program of exercise, smoking cessation, and optimization of medical therapy, but found no significant improvement in respiratory function from baseline levels (Bobbio et al 2008 ).…”

Section: Preadmission Carementioning

confidence: 99%

Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care

et al. 2020

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Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria. Results Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery). Conclusions These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

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“…Several systematic reviews and meta-analyses on the effect of various preoperative interventions prior to lung cancer surgery have recently been published, reporting a reduction in postoperative (pulmonary) complications and length of hospital stay (4)(5)(6)(7). In addition to these bene ts, patients deemed un t for surgery, based on their pulmonary function test and exercise test results, could potentially become a surgical candidate with prehabilitation (8).…”

Section: Introductionmentioning

confidence: 99%

“…To date, delaying surgery for patients with lung cancer to facilitate preparation with prehabilitation cannot be recommended, because cancer could potentially progress (4,8). The Dutch national guideline for the treatment of NSCLC states that 80% of patients should have been operated on within two weeks after completion of the diagnostic phase (10).…”

Section: Introductionmentioning

confidence: 99%

Multimodal Prehabilitation in Patients with Non-Small Cell Lung Cancer Undergoing Anatomical Resection: Protocol of a Non-Randomised Feasibility Study

Molenaar

Meyenfeldt

Betue

et al. 2020

Preprint

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BackgroundThe preoperative period can be used to enhance a patient’s functional capacity with multimodal prehabilitation and, consequently improve and fasten postoperative recovery. Especially non-small cell lung cancer (NSCLC) surgical patients may benefit from this intervention, since the affected and resected organ is an essential part of the cardiorespiratory fitness. Drafting a prehabilitation programme is a challenge, since many disciplines are involved, and time between diagnosis of NSCLC and surgery is limited. We designed a multimodal prehabilitation programme prior to pulmonary surgery and conduct a study to assess feasibility and efficacy of the programme. Publication of this protocol may help other health care facilities to implement such a programme. MethodsThe multimodal prehabilitation programme consists of an exercise programme, nutritional support, mental support, smoking cessation programme, patient empowerment and respiratory optimisation. In two Dutch teaching hospitals, 40 adult patients with proven or suspected NSCLC will be included. In a non-randomised fashion, 20 patients follow the multimodal prehabilitation programme and 20 will be assessed in the control group, according to patient preference. Assessments take place at four time points: baseline, week before surgery, six weeks postoperatively and three months postoperatively. Feasibility and efficacy of the prehabilitation programme will be assessed as primary outcomes. DiscussionSince the time between diagnosis of NSCLC and surgery is limited, it is a challenge to implement a prehabilitation programme. This study will assess whether this is feasible and effective. The non-randomised fashion of the study might result in a selection bias. However, the control group is necessary, to put the prehabilitation group in perspective and to assess feasibility further. By publishing this protocol of our feasibility study, we aim to facilitate others to evaluate and implement a multimodal prehabilitation programme for surgical lung cancer patients.Trial registrationThis feasibility study is registered as NL8080 in the Netherlands Trial Register on the 10th of October 2019, https://www.trialregister.nl/trial/8080. Secondary identifiers: CCMO (Central Committee on Research Involving Human Subjects) number NL70578.015.19, reference number of the Medical Ethical Review Committee of Máxima MC W19.045.

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The key questions in rehabilitation in thoracic surgery

Cited by 14 publications

References 63 publications

National survey of enhanced recovery after thoracic surgery practice in the United Kingdom and Ireland

National survey of enhanced recovery after thoracic surgery practice in the United Kingdom and Ireland

Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care

Multimodal Prehabilitation in Patients with Non-Small Cell Lung Cancer Undergoing Anatomical Resection: Protocol of a Non-Randomised Feasibility Study

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