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Review
. 2017;7(4):340-349.
doi: 10.1007/s40140-017-0245-2. Epub 2017 Nov 7.

Prehabilitation and Nutritional Support to Improve Perioperative Outcomes

Malcolm A West  1   2   3   4 , Paul E Wischmeyer  5   6 , Michael P W Grocott  2   3   4   7
Affiliations
Review

Prehabilitation and Nutritional Support to Improve Perioperative Outcomes

Malcolm A West et al. Curr Anesthesiol Rep. 2017.

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.

Keywords: Exercise; Mortality; Multimodal prehabilitation; Nutrition; Postoperative outcome; Stress of surgery.

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Conflict of interest statement

Conflict of Interest

Malcolm A. West is supported through a grant from the National Institute for Health Research Clinical Lectureship.

Paul E. Wischmeyer is supported through grants from the National Institutes of Health (NIH)/NHLBI Improving Nutrition Delivery in Acute Illness (R34 HL109369), Canadian Institutes of Health Research, Baxter, Fresenius, Lyric Pharmaceuticals, Isomark, Inc., and Medtronic; and has also served as a consultant on improving nutrition care in the ICU and perioperative medicine to Nestlé, Abbott Laboratories, Fresenius, Baxter, Medtronic, Nutricia, Lyric Pharmaceuticals, and Takeda; and he is the Associate Editor of Clinical Nutrition (Elsevier).

Michael P. W. Grocott is supported through a grant from the National Institute for Health Research for the Fit-4-Surgery program; is the NIHR CRN National Specialty Lead for Anaesthesia, Perioperative Medicine and Pain; is Joint Editor-in-Chief, Extreme Medicine and Physiology (BioMed Central); Associate Editor of Perioperative Medicine (BioMed Central); Board member of the Evidence Based Perioperative Medicine (EBPOM) Community Interest Company; member of the Medical Advisory Board of Sphere Medical Ltd.; Director of Oxygen Control Systems Ltd.; has received honoraria for speaking and/or travel expenses from Edwards Lifesciences (2009 and 2016), Fresenius-Kabi (2008), BOC Medical (Linde Group) (2008), Ely-Lilly Critical Care (2008), and Cortex GmBH (2008 and 2009); Elected council member of the Royal College of Anaesthetists; Elected Board member of the Faculty of Intensive Care Medicine; President-elect of the Critical Care Medicine Section of the Royal Society of Medicine; and a Board member of the National Institute of Academic Anaesthesia.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Preoperative nutrition score (PONS) assessment tool with an example of a preoperative nutritional care pathway for high nutrition risk patients—as defined by any positive response on the PONS score. (Currently utilized by Duke University Perioperative Optimization Team (POET) Nutrition Clinic). POQI copyright adapted from reference [49]
See this image and copyright information in PMC

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