TY  - JOUR
A1  - Sliwinski, Svenja
A1  - Werneburg, Elisabeth
A1  - Faqar-Uz-Zaman, Sara Fatima
A1  - Detemble, Charlotte
A1  - Dreilich, Julia
A1  - Mohr, Lisa
A1  - Zmuc, Dora
A1  - Beyer, Katharina
A1  - Bechstein, Wolf O.
A1  - Herrle, Florian
A1  - Malkomes, Patrizia
A1  - Reissfelder, Christoph
A1  - Ritz, Joerg P.
A1  - Vilz, Tim
A1  - Fleckenstein, Johannes
A1  - Schnitzbauer, Andreas A.
T1  - A toolbox for a structured risk-based prehabilitation program in major surgical oncology
T2  - Frontiers in Surgery
N2  - Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients’ resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in outcomes and definitions. In this scoping review, class 1 and 2 evidence was included to identify seven main aspects of prehabilitation for the treatment pathway: (i) risk assessment, (ii) FITT (frequency, interventions, time, type of exercise) principles of prehabilitation exercise, (iii) outcome measures, (iv) nutrition, (v) patient blood management, (vi) mental wellbeing, and (vii) economic potential. Recommendations include the risk of tumor progression due to delay of surgery. Patients undergoing prehabilitation should perceive risk assessment by structured, quantifiable, and validated tools like Risk Analysis Index, Charlson Comorbidity Index (CCI), American Society of Anesthesiology Score, or Eastern Co-operative Oncology Group scoring. Assessments should be repeated to quantify its effects. The most common types of exercise include breathing exercises and moderate- to high-intensity interval protocols. The program should have a duration of 3–6 weeks with 3–4 exercises per week that take 30–60 min. The 6-Minute Walking Testing is a valid and resource-saving tool to assess changes in aerobic capacity. Long-term assessment should include standardized outcome measurements (overall survival, 90-day survival, Dindo–Clavien/CCI®) to monitor the potential of up to 50% less morbidity. Finally, individual cost-revenue assessment can help assess health economics, confirming the hypothetic saving of 8fortreatmentfor1 spent for prehabilitation. These recommendations should serve as a toolbox to generate hypotheses, discussion, and systematic approaches to develop clinical prehabilitation standards.
Y1  - 2023
UR  - https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/123727
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:384-opus4-1237276
SN  - 2296-875X
VL  - 10
SP  - 1186971
PB  - Frontiers Media SA
ER  -