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Prehabilitation bundle can reduce incidence of postoperative pulmonary complications

Czech version

Authors: O. Ryska 1,2;  A. Dereham 2;  S. Mahmoud 2;  N. Helmy 2;  E. Janta 2
Authors‘ workplace: Ústav živočišné fyziologie a genetiky Akademie věd České republiky, v. v. i., Liběchov, Česká republika 1;  Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, United Kingdom 2
Published in: Rozhl. Chir., 2023, roč. 102, č. 7, s. 277-282.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2023.102.7.277–282

Overview

Introduction: Elective major colorectal surgery is still associated with postoperative morbidity and mortality. Preoperative optimization can potentially reduce postoperative pulmonary complications, which significantly prolong recovery and increase the risk of mortality. The aim of this study was to evaluate the effect of the prehabilitation bundle on postoperative pulmonary complications.

Methods: All patients undergoing elective colorectal procedure for benign or malignant diagnosis before and after the introduction of the prehabilitation bundle were enrolled in the study. Prehabilitation was focused on nutritional support, regular aerobic and muscle strength exercise, preoperative optimization of anaemia, improvement of oral hygiene including regular chlorhexidine mouth wash, psychological support, restriction of smoking and alcohol consumption. In addition to the general characteristics, compliance with individual measures, incidence of pulmonary complications and length of stay were monitored.

Results: A total of 596 patients were included in the study (226 before and 370 after the implementation of the package). After the introduction of prehabilitation, the incidence of postoperative pulmonary complications decreased significantly − 29 (13%) vs. 17 (4.6%), RR: 0.21−0.67), p=0.001 and shorter length of stay was observed à 9.7 (±8.8) to 7.7 (±5.5) days (p=0.0005). Except for optimization of anaemia, compliance with the individual components of the established bundle was very good.

Conclusion: Introduction of a prehabilitation bundle focused on improvement of cardiorespiratory capacity, optimization of diet and oral hygiene, can reduce the risk of postoperative pulmonary complications and shorten the length of stay.

Keywords:

colorectal surgery – prehabilitation – postoperative pulmonary complications

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Labels
Surgery Orthopaedics Trauma surgery
ERAS
Methodology for implementing early recovery after surgery protocols in colorectal surgery
Clinical practice guidelines for perioperative care in bariatric surgery 2023: Adapted ERAS (enhanced recovery after surgery) guidelines with consensual voting of the working group of the Joint Bariatric and Metabolic Surgery Section of the Czech Surgery…
Preoperative nutritional management – compliance with current guidelines
Z 9. světového kongresu společnosti ERAS – Lisabon 2023
Article was published in

Perspectives in Surgery

Issue 7
2023 Issue 7
Most read in this issue
Topics Journals
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