Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Anesthesiology Reports
Published in: Current Anesthesiology Reports 4/2017

Open Access 01-12-2017 | Geriatric Anesthesia (S Akhtar, Section Editor)

Prehabilitation and Nutritional Support to Improve Perioperative Outcomes

Authors: Malcolm A. West, Paul E. Wischmeyer, Michael P. W. Grocott

Published in: Current Anesthesiology Reports | Issue 4/2017

Login to get access

Abstract

Purpose of Review

The purpose of this study is to evaluate the role of physical exercise and nutrition interventions in adult patients before elective major surgery.

Recent Findings

Exercise training before elective adult major surgery is feasible, safe, and efficacious, but the clinical effectiveness remains uncertain. Early data suggests a reduction in morbidity, length of stay, and quality of life, but the results of larger definitive studies are awaited. Nutritional interventions are less well evaluated and when they are, it is often in combination with exercise interventions as part of a prehabilitation package.

Summary

Studies evaluating exercise and nutrition interventions before elective major surgery in adults are producing encouraging early results, but definitive clinical evidence is currently very limited. Future research should focus on refining interventions, exploring mechanism, and evaluating the interactions between therapies and large-scale clinical effectiveness studies.
Literature
1.
Carli F, Zavorsky GS. Optimizing functional exercise capacity in the elderly surgical population. Curr Opin Clin Nutr Metab Care. 2005;8(1):23–32.CrossRefPubMed
2.
Lassen K, Soop M, Nygren J. Consensus review of optimal perioperative care in colorectal surgery. Am Med Assoc. 2009;144(10):961–9.
3.
Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012;380(9847):1059–65.CrossRefPubMedPubMedCentral
4.
•• Pearse RM. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2016;117(5):601–9. As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.CrossRef
5.
Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326–43.PubMedPubMedCentral
6.
Cornellà N, Sancho J, Sitges-Serra A. Short and long-term outcomes after surgical procedures lasting for more than six hours. Sci Rep. 2017;7(1):1–8.CrossRef
7.
Grocott MPW, Plumb JOM, Edwards M, Fecher-Jones I, Levett DZH. Re-designing the pathway to surgery: better care and added value. Perioperative Medicine. 2017;6(1):9.CrossRefPubMedPubMedCentral
8.
9.
Bozzetti F, Gianotti L, Braga M, Di Carlo V, Mariani L. Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support. Clin Nutr. 2007;26(6):698–709.CrossRefPubMed
10.
Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology. 2013;28(5):330–58.CrossRefPubMed
11.
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219–29.CrossRefPubMedPubMedCentral
12.
Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305.CrossRefPubMed
13.
• Moore SC, Lee I-M, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816–25. This study determines the association of leisure-time physical activity with the incidence of common types of cancer and whether associations vary by body size or smoking. A total of 1.44 million participants were included in a study that found that leisure-time physical activity was associated with lower risks of many cancer types.CrossRefPubMed
14.
Liu L, Shi Y, Li T, Qin Q, Yin J, Pang S, et al. Leisure time physical activity and cancer risk: evaluation of the WHO’s recommendation based on 126 high-quality epidemiological studies. Br J Sports Med. 2016;50(7):1–9.
15.
• Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol. 2017;18(8):e457–71. Physical activity, sedentary behaviour, and diet are increasingly being studied for their associations with cancer. Physical activity is inversely associated with, and sedentary behaviour is positively associated with, an increased risk of more than ten types of cancer. Emerging randomized controlled trials of physical activity and dietary factors and mechanistic studies of immunity, inflammation, extracellular matrix mechanics, epigenetic or transcriptional regulation, protein translation, circadian disruption, and interactions of the multibiome with lifestyle factors will be crucial to advance this field.CrossRefPubMed
16.
•• Moran J, Wilson F, Guinan E, McCormick P, Hussey J, Moriarty J. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. Br J Anaesth. 2016;116(2):177–91. Cardiopulmonary exercise testing (CPET) is used as a preoperative risk-stratification tool for patients undergoing non-cardiopulmonary intra-abdominal surgery. Further research is needed to justify the ability of CPET to predict postoperative outcome.CrossRefPubMed
17.
Valkenet K, van de Port IGL, Dronkers JJ, de Vries WR, Lindeman E, Backx FJG. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil. 2011;25(2):99–111.CrossRefPubMed
18.
Mayo NE, Feldman L, Scott S, Zavorsky G, Kim DJ, Charlebois P, et al. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery. 2011;150(3):505–14.CrossRefPubMed
19.
West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, et al. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2015;114(2):244–51.CrossRefPubMed
20.
Doherty AFO, West M, Jack S, Grocott MPW. Preoperative aerobic exercise training in elective intra-cavity surgery: a systematic review. Br J Anaesth. 2013;110(5):679–89.CrossRef
21.
Singh F, Newton R, Galvao D, Spry N, Baker M. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol. 2013;22(2):92–104.CrossRefPubMed
22.
• van Rooijen SJ, Engelen MA, Scheede-Bergdahl C, Carli F, RMH R, Slooter GD, et al. Systematic review of exercise training in colorectal cancer patients during treatment. Int J Lab Hematol. 2016;38(1):8–13. Colorectal cancer surgery results in considerable postoperative morbidity, mortality, and reduced quality of life. As many patients will undergo additional (neo)adjuvant therapy, it is imperative that individuals optimize their physical function. This systematic review investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients. There is limited evidence available on exercise training during treatment in colorectal cancer patients.CrossRef
23.
• Loughney L, West MA, Kemp GJ, Grocott MPW, Jack S. Exercise intervention in people with cancer undergoing neoadjuvant cancer treatment and surgery: a systematic review. Eur J Surg Oncol. 2016;42(1):28–38. Exercise prehabilitation appears to be beneficial in decreasing the incidence of postoperative complications; however, more high-quality studies are needed to validate its use in the preoperative setting especially in patients undergoing cancer treatments.CrossRefPubMed
24.
• Loughney L, West MA, Kemp GJ, Grocott MPW, Jack S. Exercise intervention in people with cancer undergoing adjuvant cancer treatment following surgery: a systematic review. Eur J Surg Oncol. 2015;41(12):1590–602. Exercise prehabilitation appears to be beneficial in decreasing the incidence of postoperative complications; however, more high-quality studies are needed to validate its use in the preoperative setting especially in patients undergoing cancer treatments.CrossRefPubMed
25.
Hornsby WE, Douglas PS, West MJ, Kenjale AA, Lane AR, Schwitzer ER, et al. Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial. Acta Oncol. 2014;53(1):65–74.CrossRefPubMed
26.
Weston M, Weston KL, Prentis JM, Snowden CP. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions. Perioper Med. 2016;5(1):2.CrossRef
27.
Bruns ERJ, van den Heuvel B, Buskens CJ, van Duijvendijk P, Festen S, Wassenaar EB, et al. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Color Dis. 2016;18(8):O267–77.CrossRef
28.
Hijazi Y, Gondal U, Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg. 2017;39:156–62.CrossRefPubMed
29.
•• Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery. 2016;160(5):1189–201. Exercise prehabilitation appears to be beneficial in decreasing the incidence of postoperative complications; however, more high-quality studies are needed to validate its use in the preoperative setting especially in patients undergoing cancer treatments.CrossRefPubMed
30.
Elliott AD, Rajopadhyaya K, Bentley DJ, Beltrame JF, Aromataris EC. Interval training versus continuous exercise in patients with coronary artery disease: a meta-analysis. Hear Lung Circ. 2015;24(2):149–57.CrossRef
31.
Courneya KS, Booth CM, Gill S, O'Brien P, Vardy J, Friedenreich CM, et al. The colon health and life-long exercise change trial: a randomized trial of the National Cancer Institute of Canada Clinical Trials Group. Curr Oncol. 2008;15(6):8–16.CrossRef
32.
• Thomas MN, Kufeldt J, Kisser U, Hornung H-M, Hoffmann J, Andraschko M, et al. Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G-DRG-system. Nutrition. 2016;32(2):249–54. Malnutrition is known to independently affect patient outcomes. The aims of this study were to investigate the prevalence of malnutrition in patients undergoing elective surgery and to analyze the effects of malnutrition on morbidity, mortality, and hospital length of hospital (LOS). Establishment of a structured, comprehensive assessment of the nutritional status of hospitalized patients can reliably identify patients at risk for malnutrition.CrossRefPubMed
33.
•• Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50. Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g., for cancer, and of those developing severe complications despite best perioperative care. The guideline presents 37 recommendations for clinical practice.CrossRefPubMed
34.
Correia MITD, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235–9.CrossRefPubMed
35.
Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215(3):322–30.CrossRefPubMedPubMedCentral
36.
Drover JW, Cahill NE, Kutsogiannis J, Pagliarello G, Wischmeyer P, Wang M, et al. Nutrition therapy for the critically ill surgical patient: we need to do better! J Parenter Enter Nutr United States. 2010;34(6):644–52.CrossRef
37.
Awad S, Lobo DN. What’s new in perioperative nutritional support? Curr Opin Anaesthesiol. 2011;24(3):339–48.CrossRefPubMed
38.
Drover JW, Cahill NE, Kutsogiannis J, Pagliarello G, Wischmeyer P, Wang M, et al. Nutrition therapy for the critically ill surgical patient: we need to do better! J Parenter Enter Nutr. 2010;34(6):644–52.CrossRef
39.
Osland E, Yunus RM, Khan S, Memon MA. Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. J Parenter Enter Nutr. 2011;35(4):473–87.CrossRef
40.
Ferrando AA, Paddon-Jones D, Hays NP, Kortebein P, Ronsen O, Williams RH, et al. EAA supplementation to increase nitrogen intake improves muscle function during bed rest in the elderly. Clin Nutr. 2010 Feb;29(1):18–23.CrossRefPubMed
41.
Beasley JM, LaCroix AZ, Neuhouser ML, Huang Y, Tinker L, Woods N, et al. Protein intake and incident frailty in the Women’s Health Initiative observational study. J Am Geriatr Soc. 2010;58(6):1063–71.CrossRefPubMedPubMedCentral
42.
•• Yeung SE, Hilkewich L, Gillis C, Heine JA, Fenton TR. Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery. Am J Clin Nutr. 2017;106(1):44–51. Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. This prospective cohort study shows that ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥ 60% protein needs after surgery and malnutrition screening tool scores were independent predictors of length of stay.PubMed
43.
von Haehling S, Anker SD. Prevalence, incidence and clinical impact of cachexia: facts and numbers—update 2014. J Cachexia Sarcopenia Muscle. 2014;5(4):261–3.CrossRef
44.
Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539–47.CrossRefPubMed
45.
Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33(1):90–9.CrossRefPubMed
46.
• da Silva Fink J, Daniel de Mello P, Daniel de Mello E. Subjective global assessment of nutritional status—a systematic review of the literature. Clin Nutr. 2015;34(5):785–92. Subjective Global Assessment (SGA) is a nutritional assessment tool widely used in hospital clinical practice, even though it is not ideal. This systematic review intended to update knowledge on the performance of SGA as a method for the assessment of the nutritional status of hospitalized adults. SGA is a valid tool for the nutritional diagnosis of hospitalized clinical and surgical patients and points to a potential superiority of nutritional screening methods in the early detection of malnutrition.CrossRefPubMed
47.
•• van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de HCW V. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr. 2014;33(1):39–58. Numerous nutrition screening tools for the hospital setting have been developed. The aim of this systematic review was to construct or validate criterion and determine the predictive validity of nutrition screening tools for the general hospital setting. Eighty-three studies (32 screening tools) were identified. Not one single screening or assessment tool is capable of adequate nutrition screening as well as predicting poor nutritio-related outcome. Development of new tools seems redundant and will most probably not lead to new insights. New studies comparing different tools within one patient population are required.CrossRefPubMed
48.
• Williams JD, Wischmeyer PE. Assessment of perioperative nutrition practices and attitudes—a national survey of colorectal and GI surgical oncology programs. Am J Surg. 2017;213(6):1010–8. This study broadly describes nutritional practices and attitudes of gastrointestinal and oncologic surgeons across the USA. Surgeons recognize both the importance of proper perioperative surgical nutritional support and the potential value to their practice in terms of outcomes, but this study confirms poor implementation of evidence-based nutrition practices in GI and oncologic surgery programs. This study describes a significant opportunity to capitalize on current favorable surgeon beliefs (and positive published data) regarding the benefit of perioperative nutrition to improve surgical nutrition practice and patient outcomes in the USA.CrossRefPubMed
49.
•• Wischmeyer P, Carli F, Evans D, Gilbert S, Kozar R, Pryor A, et al. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative 2 (POQI-2) joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesthesia and Analgesia. 2017; in press. Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that sub-optimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the USA has been quite limited and needs to be addressed in surgery-focused recommendations. Implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization is essential, together with immediate postoperative nutrition delivery after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often inadequate nutrition intake in the post-hospital setting was discussed, and the role of post-discharge oral nutrition supplements was emphasized.
50.
51.
• Bohl DD, Shen MR, Kayupov E, Della Valle CJ. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplast. 2016;31(1):15–21. This study investigates the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the 30 days after total joint arthroplasty. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin concentration < 3.5 g/dL) with adjustment for patient and procedural factors. A total of 49,603 patients were included. In comparison to patients with normal albumin concentration, patients with hypoalbuminemia had a higher risk for surgical site infection, pneumonia, extended length of stay, and readmission. Future efforts should investigate methods of correcting nutritional deficiencies prior to total joint arthroplasty. If successful, such efforts could lead to improvements in short-term outcomes for patients.CrossRef
52.
Jiang N, Deng J-Y, Ding X-W, Ke B, Liu N, Zhang R-P, et al. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol. 2014;20(30):10537–44.CrossRefPubMedPubMedCentral
53.
Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J, et al. Nutritional assessment: a comparison of clinical judgement and objective measurements. N Engl J Med. 1982;306(16):969–72.CrossRefPubMed
54.
Kruizenga HM, Seidell JC, de Vet HCW, Wierdsma NJ, van Bokhorst-de van der Schueren MAE. Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr. 2005;24(1):75–82.CrossRefPubMed
55.
Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev England. 2012;11:CD008879.
56.
•• Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015;22(Suppl 3):S778–85. Malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. The aims of this study were to investigate the prevalence of malnutrition and identify the optimal preoperative nutritional support for preventing postoperative surgical site infections (SSIs) in malnourished gastric cancer patients undergoing gastrectomy. Malnutrition, a risk factor for SSI, was prevalent in gastric cancer patients preoperatively. Well-managed preoperative nutritional support decreased the incidence of postoperative SSIs in malnourished patients.CrossRefPubMed
57.
Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Engl J Med. 1991;325(8):525–32.CrossRef
58.
Bozzetti F, Gavazzi C, Miceli R, Rossi N, Mariani L, Cozzaglio L, et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. JPEN J Parenter Enteral Nutr. 2000;24(1):7–14.CrossRefPubMed
59.
Von Meyenfeldt MF, Meijerink WJ, Rouflart MM, Builmaassen MT, Soeters PB. Perioperative nutritional support: a randomised clinical trial. Clin Nutr. 1992;11(4):180–6.CrossRef
60.
Klein S, Kinney J, Jeejeebhoy K, Alpers D, Hellerstein M, Murray M, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Clin Nutr. 1997;16(4):193–218.CrossRefPubMed
61.
Heyland DK, Montalvo M, MacDonald S, Keefe L, Su XY, Drover JW. Total parenteral nutrition in the surgical patient: a meta-analysis. Can J Surg. 2001;44(2):102–11.PubMed
62.
Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev. 2012;11(2):278–96.CrossRefPubMed
63.
•• Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016;35(2):370–80. There is limited information about the economic impact of nutritional support despite its known clinical benefits. This systematic review examined the cost and cost effectiveness of using standard (non-disease specific) oral nutritional supplements (ONS) administered in the hospital setting only. This review suggests that standard ONS in the hospital setting produce a cost saving and are cost effective. The evidence base could be further strengthened by prospective studies in which the primary outcome measures are economic.CrossRefPubMed
64.
Stratton RJ, Hebuterne X, Elia M. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions. Ageing Res Rev. 2013;12(4):884–97.CrossRefPubMed
65.
Philipson TJ, Snider JT, Lakdawalla DN, Stryckman B, Goldman DP. Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care. 2013;19(2):121–8.PubMed
66.
Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc. 2013;27(4):1072–82.CrossRefPubMed
67.
• Gillis C, Loiselle S-E, Fiore JF, Awasthi R, Wykes L, Liberman AS, et al. Prehabilitation with whey protein supplementation on perioperative functional exercise capacity in patients undergoing colorectal resection for cancer: a pilot double-blinded randomized placebo-controlled trial. J Acad Nutr Diet. 2015;116(5):802–12. Clinically meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation. These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery.CrossRefPubMed
68.
Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, et al. Prehabilitation versus rehabilitation: a randomized control trial in patinets undergoing colorectal resection for cancer. Anesthesiology. 2015;122(6):1438.CrossRefPubMed
69.
Burden ST, Hill J, Shaffer JL, Campbell M, Todd C. An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients. J Hum Nutr Diet. 2011;24(5):441–8.CrossRefPubMed
70.
Smedley F, Bowling T, James M, Stokes E, Goodger C, O’Connor O, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care. Br J Surg. 2004;91(8):983–90.CrossRefPubMed
71.
• Denison H, Cooper C, Sayer AA, Robinson SM. Prevention and optimal management of sarcopenia: a review of combined exercise and nutrition interventions to improve muscle outcomes in older people. Clin Interv Aging. 2015;10:859–69. The growing recognition of sarcopenia, the age-related loss of skeletal muscle mass and function, has highlighted the need to understand more about its etiology. Declines in muscle mass and strength are expected aspects of aging, but there is significant variability between individuals in rates of loss. In a comprehensive review of the literature, we consider 17 studies of older adults (≥ 65 years) in which combined nutrition and exercise interventions were used to increase muscle strength and/or mass and achieve improvements in physical performance. The main message is that enhanced benefits of exercise training, when combined with dietary supplementation, have been shown in some trials—indicating potential for future interventions, but that existing evidence is inconsistent. Further studies are needed, particularly of exercise training combined with dietary strategies that increase intakes of a range of nutrients, as well as bioactive non-nutrients, to provide the evidence on which public health and clinical recommendations can be based.PubMedPubMedCentral
72.
•• Beaudart C, Dawson A, Shaw SC, Harvey NC, Kanis JA, Binkley N, et al. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporos Int. 2017;28(6):1817–33. This systematic review summarizes the effect of combined exercise and nutrition intervention on muscle mass and muscle function. A total of 37 RCTs were identified. Physical exercise has a positive impact on muscle mass and muscle function in healthy subjects aged 60 years and older. The biggest effect of exercise intervention, of any type, has been seen on physical performance. We observed huge variations in regard to the dietary supplementation protocols. Based on the included studies, mainly performed on well-nourished subjects, the interactive effect of dietary supplementation on muscle function appears limited.CrossRefPubMedPubMedCentral
Metadata
Title
Prehabilitation and Nutritional Support to Improve Perioperative Outcomes
Authors
Malcolm A. West
Paul E. Wischmeyer
Michael P. W. Grocott
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 4/2017
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-017-0245-2

Other articles of this Issue 4/2017

Current Anesthesiology Reports 4/2017 Go to the issue

Geriatric Anesthesia (S Akhtar, Section Editor)

Regional Versus General Anesthesia in the Elderly: New Insights

Advances in Monitoring for Anesthesia (LAH Critchley, Section Editor)

Volume Assessment by Inferior Vena Cava Examination: Bedside Ultrasound Techniques and Practical Difficulties

Geriatric Anesthesia (S Akhtar, Section Editor)

Intraoperative Noninvasive Cardiovascular and Brain Monitoring in the Elderly

Advances in Monitoring for Anesthesia (LAH Critchley, Section Editor)

Stroke Volume Monitoring: Novel Continuous Wave Doppler Parameters, Algorithms and Advanced Noninvasive Haemodynamic Concepts

Patient Safety in Anesthesia (A Barbeito, Section Editor)

Transitions of Care in the Perioperative Period

Geriatric Anesthesia (S Akhtar, Section Editor)

Postoperative Cognitive Dysfunction