The Operating Theatre Journal - Journal - Page 14
Preoperative Optimisation: The effect of Prehabilitation Interventions
on the Postoperative Recovery of Cancer Patients undergoing
Colorectal Surgery – Literature Review and Discussion Based Paper
Author: Katie McCallum (FHEA)
Senior Lecturer and Course Lead in Operating Department Practice – Sheffield Hallam University
Submission to The Operating Theatre Journal - (The OTJ)
Article is approximately 3,000 words inclusive of abstract, references and any text in tables and figures.
Abstract
Historically it has been considered that preoperative patient
optimisation is highly beneficial for patients undergoing anaesthesia
and surgical intervention or treatment. Exploration of the concept and
effect of prehabilitation interventions on the postoperative recovery
of cancer patients will be explored and discussed through reviewing
literature, with a focus on those undergoing colorectal cancer surgery.
Keywords:
Prehabilitation, perioperative intervention, patient optimisation,
postoperative outcome, cancer, colorectal cancer
Introduction
It is recognised by clinicians working in the perioperative environment,
that postoperative complications often display a link to an individual’s
preoperative health state and is widely reported that optimal or improved
overall health will encourage a faster return to normal functioning,
improving post operative outcomes. Decreased perioperative morbidity
and mortality because of optimisation is also considered to be cost
effective. This is due to a reduction in perioperative complications and
the financial burden associated to treating them (Singh, 2008). It is
important to mention that slower return to function post operatively
can negatively impact an individual’s ability to reintegrate socially and
affect the way they heal psychologically. This can happen in a variety
of ways, for example, it may impact returning to work or hobbies, in
turn removing social contact or personal gratification opportunities. A
loss of a physiological function could impede confidence and initiate
embarrassment, stress, or anxiety due to dysfunction or altered selfreliance (Averyt and Nishimoto, 2014).
advice, psychological and physiological assessment and referral to
services. Though it is key to note that there are no specific or definitive
recommendations or guidelines in place at present for a definitive
collaborative or multimodal prehabilitation strategy. Therefore, an
opportunity is available for an approach incorporating psychological
and physical assessment where set parameters should be considered,
inclusive of the optimisation of physiological condition prior to surgery
(Peri Operative Programme, 2022).
This discussion article will explore the effect of prehabilitation
interventions on the post operative recovery of cancer patients
undergoing colorectal surgery, and will be achieved by searching
for, reviewing, analysing, and appraising the current literature and
evidence base available.
Search of the Literature
Search Strategy - a review of the available literature was conducted to
assist discussion, using the following criteria in the CINAHL Complete
database.
Literature Search Terms via CINAHL
(Prehabilitation or prehab or pre-
Complete
operative rehabilitation) OR
preoperative optimisation AND surgical
outcomes AND cancer
Limiters applied to ensure a current
Abstract Available; Published Date:
yield suitable to the chosen topic
20150101-20220231; English
Language; Peer Reviewed; Research
Traditionally emphasis has been placed on the post operative period for
recovery-based rehabilitation, and in recent years it has been identified
that the implementation of contemporary clinical innovations in
practice such as Enhanced Recovery Protocols (ERPs) and Enhanced
Recovery After Surgery (ERAS) have had a highly positive impact on
post operative outcomes for cancer patients, by optimisation of
physiological capacity and functional performance perioperatively
(Moningi et al, 2019).
Tevis and Kennedy (2016) state that approximately one third of
surgical colorectal cancer patients experience complications and have
an increased likelihood of morbidity postoperatively. Furthermore,
an expression is observed highlighting the need for physiological
improvement programmes known as prehabilitation, to be implemented
with the baseline status of functional capacity to be recorded. This will
enable accurate provision of information for patients requiring surgery,
inclusive of individualised risk assessment and likelihood of postsurgical morbidity. Similarly, Mayo et al. (2011) refers to the concept of
prehabilitation as a programme or package which has been developed
with the purpose of improving functional capacity and physiological
reserve in anticipation of an approaching stressor, such as surgical
intervention. Interestingly, earlier functional recovery has also been
associated to patients with a positive attitudinal approach, sense of
control over their disease or diagnosis, and assured perception of self
(Levett and Grimmett, 2019).
This gives momentum to the ongoing conversation surrounding early
intervention in the preoperative period as opposed to rehabilitation
postoperatively. Can prehabilitation be achieved and does it enhance
post operative recovery for cancer patients? Are there any barriers to
implementation of proposed strategies? Many uni modal prehabilitation
strategies co-exist for cancer patients and are already widely applied
in this field and include patient education, dietary and nutritional
14
Article; Language: English; Publication
Type: Journal Article; Age Groups: All
Adult
Search Mode
Boolean/Phrase
Results
40 results presented - 3 most suitable
reviewed after elimination process
Study Selection
To ensure a focused review I opted to limit my discussion to colorectal
cancer surgeries which narrowed the yield of results. After reviewing
titles and abstracts to eliminate unsuitable literature a total of three
articles have been incorporated into the review.
As this is an area of research still in its infancy, a notable finding was the
limited yield obtained from the search conducted and the presentation
of similarity in terms of the research methodology.
For this reason, literature selected from the reference lists of these
studies and through wider reading will be incorporated into the
discussion.
The three articles reviewed from the initial search of the database
were prospective or randomised controlled trials (RCT) which is not
uncommon when attempting to measure the effectiveness of a new
practice or intervention in healthcare (Hariton and Locascio, 2018).
Notably an instant commonality was identified regarding a clear theme
of Functional Capacity and Health Related Quality of Life (HRQoL) being
apparent.
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