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Review
. 2024 Jun 6;16(11):1783.
doi: 10.3390/nu16111783.

Multimodal Prehabilitation for Patients with Crohn's Disease Scheduled for Major Surgery: A Narrative Review

Camilla Fiorindi  1   2 , Francesco Giudici  3 , Giuseppe Dario Testa  2   4 , Lorenzo Foti  2   5 , Sara Romanazzo  1   2 , Cristina Tognozzi  1   2 , Giovanni Mansueto  1   2 , Stefano Scaringi  3 , Francesca Cuffaro  1 , Anita Nannoni  1 , Mattias Soop  6 , Gabriele Baldini  1   2   5
Affiliations
Review

Multimodal Prehabilitation for Patients with Crohn's Disease Scheduled for Major Surgery: A Narrative Review

Camilla Fiorindi et al. Nutrients. .

Abstract

Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.

Keywords: Crohn’s disease; Enhanced Recovery After Surgery (ERAS); multimodal; nutrition; prehabilitation; surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Objectives of perioperative nutritional interventions in patients with inflammatory bowel disease.
Figure 2
Figure 2
Proposed assessment and therapeutic approaches to preoperative psychological distress: A patient with Crohn’s disease reporting disruptive beliefs about surgery, psychological distress, depressive and anxious symptoms, and poor well-being. The therapist could give priority to cognitive behavioural therapy (CBT) to identify and restructuring disruptive beliefs on surgery in order to reduce psychological distress, depressive and anxious symptoms. Then, the therapist could decide to improve well-being via Well-Being Therapy (WBT) techniques.
See this image and copyright information in PMC

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