Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial
Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial
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DOI：
10.1097/sla.0000000000002293
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发表时间：
2018-01-01
影响因子：
9
通讯作者：
Martinez-Palli, Graciela
中科院分区：
文献类型：
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作者：
Barberan-Garcia, Anael;Ubre, Marta;Martinez-Palli, Graciela
目的：本研究的目的是评估个性化康复对高危择期腹部大手术患者术后并发症的影响。背景资料：腹部大手术患者的预康复，包括耐力运动训练和促进身体活动，被认为是减少术后并发症的有效预防干预措施。然而，现有的研究提供了有争议的结果，并显示出对低风险患者的明显偏见。方法：采用随机、盲法对照试验。接受参与的合格候选人按1:1的比例随机分为对照组（标准治疗）或干预组（标准治疗+康复）。纳入标准为：i)年龄0 ~ 70岁；和/或，ii)美国麻醉医师学会评分III/IV。预适应包括3个行动：i)动机性访谈；Ii)高强度耐力训练；促进体育活动。主要研究结果为患者术后并发症的比例。次要结果包括耐力时间（ET）在循环力量计运动。结果：71例患者随机分为对照组，73例患者分为干预组。在因手术方案改变而排除19例患者后，63例对照患者和62例干预患者被纳入意向治疗分析。干预组有氧运动能力增强[ET 135 (218) %；P < 0.001)，与对照组相比，术后并发症患者数量减少51%（相对危险度0.5；95%可信区间0.3-0.8；P=0.001），并发症发生率[1.4（1.6）和0.5 (1.0)(P=0.001)]。结论：预适应训练提高了高危择期腹部大手术患者的术后临床效果，这可能与有氧能力的增加有关。
Objective:The aim of this study was to assess the impact of personalized prehabilitation on postoperative complications in high-risk patients undergoing elective major abdominal surgery.Summary Background Data:Prehabilitation, including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surgery has been postulated as an effective preventive intervention to reduce postoperative complications. However, the existing studies provide controversial results and show a clear bias toward low-risk patients.Methods:This was a randomized blinded controlled trial. Eligible candidates accepting to participate were blindly randomized (1:1 ratio) to control (standard care) or intervention (standard care+prehabilitation) groups. Inclusion criteria were: i) age >70 years; and/or, ii) American Society of Anesthesiologists score III/IV. Prehabilitation covered 3 actions: i) motivational interview; ii) high-intensity endurance training; and promotion of physical activity. The main study outcome was the proportion of patients suffering postoperative complications. Secondary outcomes included the endurance time (ET) during cycle-ergometer exercise.Results:We randomized 71 patients to the control arm and 73 to intervention. After excluding 19 patients because of changes in the surgical plan, 63 controls and 62 intervention patients were included in the intention-to-treat analysis. The intervention group enhanced aerobic capacity [ET 135 (218) %; P < 0.001), reduced the number of patients with postoperative complications by 51% (relative risk 0.5; 95% confidence interval, 0.3-0.8; P = 0.001) and the rate of complications [1.4 (1.6) and 0.5 (1.0) (P=0.001)] as compared with controls.Conclusion:Prehabilitation enhanced postoperative clinical outcomes in high-risk candidates for elective major abdominal surgery, which can be explained by the increased aerobic capacity.