Prehabilitation, enhanced recovery after surgery, or both? A narrative review
Chelsia Gillis, Olle Ljungqvist, Francesco Carli, Chelsia Gillis, Olle Ljungqvist, Francesco Carli
Abstract
This narrative review presents a biological rationale and evidence to describe how the preoperative condition of the patient contributes to postoperative morbidity. Any preoperative condition that prevents a patient from tolerating the physiological stress of surgery (e.g. poor cardiopulmonary reserve, sarcopaenia), impairs the stress response (e.g. malnutrition, frailty), and/or augments the catabolic response to stress (e.g. insulin resistance) is a risk factor for poor surgical outcomes. Prehabilitation interventions that include exercise, nutrition, and psychosocial components can be applied before surgery to strengthen physiological reserve and enhance functional capacity, which, in turn, supports recovery through attaining surgical resilience. Prehabilitation complements Enhanced Recovery After Surgery (ERAS) care to achieve optimal patient outcomes because recovery is not a passive process and it begins preoperatively.
Keywords: enhanced recovery pathway; fast-track; injury; nutrition; perioperative; prehabilitation; preoperative; stress response; surgical risk.
Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
Source: PubMed