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The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review.
Colorectal Dis 2016; 18(8):O267-77CD

Abstract

AIM

Prehabilitation, defined as enhancement of the preoperative condition of a patient, is a possible strategy for improving postoperative outcome. Lack of muscle strength and poor physical condition, increasingly prevalent in older patients, are risk factors for postoperative complications. Eighty-five per cent of patients with colorectal cancer are aged over 60 years. Since surgery is the cornerstone of their treatment, this review systemically examined the literature on the effect of physical prehabilitation in older patients undergoing colorectal surgery.

METHOD

Trials and case-control studies investigating the effect of physical prehabilitation in patients over 60 years undergoing colorectal surgery were retrieved from MEDLINE, EMBASE, CINAHL and the Cochrane library. Patient characteristics, the type of intervention and outcome measurements were recorded. The risk of bias and heterogeneity was assessed.

RESULTS

Five studies including 353 patients were identified. They were small, containing an average of 77 patients and were of moderate methodological quality. Compliance rates of the prehabilitation programme varied from 16 to 97%. None of the studies could identify a significant reduction of postoperative complications or length of hospital stay. Four studies showed physical improvement (walking distance, respiratory endurance) in the prehabilitation group. Clinical heterogeneity precluded a meta-analysis.

CONCLUSION

Prehabilitation is a possible means of enhancing the physical condition of patients preoperatively. The quality of studies in older patients undergoing colorectal surgery is poor, despite the increase in elderly people with colorectal cancer. Defining specific patient groups at risk and standardizing the outcome are essential for improving the results of treatment.

Authors+Show Affiliations

Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands. Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.Department of Surgery, VU Medical Centre, Amsterdam, the Netherlands.Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.Department of Medicine, University Medical Centre, Groningen, the Netherlands.Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.Department of Medicine, University Medical Centre, Groningen, the Netherlands. Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

27332897

Citation

Bruns, E R J., et al. "The Effects of Physical Prehabilitation in Elderly Patients Undergoing Colorectal Surgery: a Systematic Review." Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, vol. 18, no. 8, 2016, pp. O267-77.
Bruns ER, van den Heuvel B, Buskens CJ, et al. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis. 2016;18(8):O267-77.
Bruns, E. R., van den Heuvel, B., Buskens, C. J., van Duijvendijk, P., Festen, S., Wassenaar, E. B., ... van Munster, B. C. (2016). The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland, 18(8), pp. O267-77. doi:10.1111/codi.13429.
Bruns ER, et al. The Effects of Physical Prehabilitation in Elderly Patients Undergoing Colorectal Surgery: a Systematic Review. Colorectal Dis. 2016;18(8):O267-77. PubMed PMID: 27332897.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. AU - Bruns,E R J, AU - van den Heuvel,B, AU - Buskens,C J, AU - van Duijvendijk,P, AU - Festen,S, AU - Wassenaar,E B, AU - van der Zaag,E S, AU - Bemelman,W A, AU - van Munster,B C, PY - 2015/11/09/received PY - 2016/04/28/accepted PY - 2016/6/23/entrez PY - 2016/6/23/pubmed PY - 2017/7/21/medline KW - Prehabilitation KW - colorectal surgery KW - elderly KW - frailty SP - O267 EP - 77 JF - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland JO - Colorectal Dis VL - 18 IS - 8 N2 - AIM: Prehabilitation, defined as enhancement of the preoperative condition of a patient, is a possible strategy for improving postoperative outcome. Lack of muscle strength and poor physical condition, increasingly prevalent in older patients, are risk factors for postoperative complications. Eighty-five per cent of patients with colorectal cancer are aged over 60 years. Since surgery is the cornerstone of their treatment, this review systemically examined the literature on the effect of physical prehabilitation in older patients undergoing colorectal surgery. METHOD: Trials and case-control studies investigating the effect of physical prehabilitation in patients over 60 years undergoing colorectal surgery were retrieved from MEDLINE, EMBASE, CINAHL and the Cochrane library. Patient characteristics, the type of intervention and outcome measurements were recorded. The risk of bias and heterogeneity was assessed. RESULTS: Five studies including 353 patients were identified. They were small, containing an average of 77 patients and were of moderate methodological quality. Compliance rates of the prehabilitation programme varied from 16 to 97%. None of the studies could identify a significant reduction of postoperative complications or length of hospital stay. Four studies showed physical improvement (walking distance, respiratory endurance) in the prehabilitation group. Clinical heterogeneity precluded a meta-analysis. CONCLUSION: Prehabilitation is a possible means of enhancing the physical condition of patients preoperatively. The quality of studies in older patients undergoing colorectal surgery is poor, despite the increase in elderly people with colorectal cancer. Defining specific patient groups at risk and standardizing the outcome are essential for improving the results of treatment. SN - 1463-1318 UR - https://www.unboundmedicine.com/medline/citation/27332897/The_effects_of_physical_prehabilitation_in_elderly_patients_undergoing_colorectal_surgery:_a_systematic_review_ L2 - https://doi.org/10.1111/codi.13429 DB - PRIME DP - Unbound Medicine ER -