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Paper name and link |
Overview |
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Large retrospective study (N 1410) looking at riks of complications post gastric surgery - different interventions compared EN, PN, IEEN and IVF. It showed that malnutrition and weight loss pre-operatively is associated with increased risk of complications |
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Nutritional screening in a cancer prehabilitation programme: A cohort study |
Prehab4cancer cohort study. Nutritional screening tool: Nutritional assessment included Patient-Generated Subjective Global Assessment (PG-SGA) Short-Form and QoL with a sit-to-stand test. Study showed that (44%) patients were at nutritional risk (score ≥ 2). During prehabilitation, 31% of patients improved their PG-SGA and 74% of patients maintained or improved their weight. |
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Prehabilitation Before Major Abdominal Surgery: A Systematic Review and Meta-analysis |
Fifteen RCTs showing Prehabilitation can reduce overall and pulmonary morbidity following surgery and could be utilised routinely. The precise protocol of prehabilitation has not been completely established. Further work is required to tailor optimal prehabilitation protocols for specific operative procedures. |
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Nutritional prehabilitation alone or combined with an exercise program significantly decreased length of hospital stay by 2 days in patients undergoing colorectal surgery. There is some evidence that multimodal prehabilitation accelerated the return to presurgical functional capacity. |
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Scored PG-SGA questionnaire, comparison of scored PG-SGA with subjective global assessment (SGA), sensitivity, specificity.The scored PG-SGA is an easy to use nutrition assessment tool that allows quick identification and prioritisation of malnutrition in hospitalised patients with cancer. |
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Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology |
Demonstrates how the nutrition care process model can be applied to nutritional prehabilitation in the pre-surgical oncology patient.Highlighting the differences between universal, targeted and specialist intervention. |
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Macmillan guidelines on prehab |
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Screening, assessment and management of perioperative malnutrition: a survey of UK practice. |
This survey highlights areas of practice where perioperative clinicians can improve the assessment and management of patients at nutritional risk prior to elective surgery. |
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perioperative nutritional support was superior in improving clinical outcomes in malnourished patients, which could significantly reduce the incidence of complications and effectively shorten the length of hospital stay. |
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Pre-operative nutrition and the elective surgical patient: Why, how and what? |
Review to explain 'why' avoiding pre-operative malnutrition and supporting protein anabolism are important goals for the elective surgical patient, 'how' peri-operative malnutrition develops leading in part to a requirement for pre-operative anabolic preparation, and 'what' can be done to avoid pre-operative malnutrition and support anabolism for optimal recovery. |
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Eleven studies with a total of 3527 patients included in this study. Postoperative overall complications were more frequent in nutritional risk patients versus patients without nutritional risk (the pooled OR 3.13 [2.51, 3.90] p<0.00001). The pooled OR of mortality for the nutritional risk group and non-nutritional risk group was 3.61 [1.38, 9.47] (p = 0.009). Furthermore, the postoperative hospital stay was significant longer in the preoperative nutritional risk group than in the nutritional normal group (WMD 5.58 [4.21, 6.95] p<0.00001). |
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Trimodal prehabilitation attenuated the post-surgical LBM loss compared to the loss observed in patients who received the rehabilitation intervention. Patients who receive neither intervention (i.e., standard of care) would be likely to lose more LBM. Offering a prehabilitation program to colorectal cancer patients awaiting resection is a useful strategy to mitigate the impact of the surgical stress response on lean tissue in an ERAS setting, and, in turn, might have a positive impact on the cancer |
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From Theory to Practice: An International Approach to Establishing Prehabilitation Programmes |
This paper gives an overview of the steps needed to take when considering the development of a prehabilitation service. It also provides examples of Prehabilitation services in three different countries including how they were developed and overall cost savings. It provides suggestions for business case development. This can therefore be a useful resource to showcase success of prehabilitation projects around the world. |
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The evaluation of prehab4cancer has relevant references in the appendices and showcases the effectiveness of prehab including cost-effectiveness that can be particularly helpful in business case writing. |
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This is a very useful website where you can put your hospital details and see average length of stay post surgery and re-admission rates post-surgery for your trust and compare it to the national average and national best - very helpful when presenting business cases to show need for improvement. |