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Advances in Perioperative Care: Challenges and Perspectives in Enhanced Recovery after Surgery, Perioperative Optimization and Prehabilitation

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (25 February 2025) | Viewed by 16169

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Dr. Carlos Cerdán Santacruz

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Guest Editor

1. Colorectal Surgery Unit, General Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain
2. Colorectal Surgery Department, Clínica Santa Elena, 28003 Madrid, Spain
Interests: oncology; colorectal cancer; rectal cancer organ preservation; proctology; inflammatory bowel disease; functional disorders; fecal incontinence; minimally invasive surgery; robotic surgery; enhanced recovery after surgery; surgery prehabilitation

Dr. Gianluca Pellino

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Guest Editor

1. Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
2. Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
Interests: artificial intelligence; prehabilitation; technologies in coloproctology; rectal cancer management; biomolecular diagnosis; translational research; robotic surgery; transanal surgery; inflammatory bowel diseases; colorectal cancer
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Special Issue Information

Dear Colleagues,

The field of perioperative care has undergone a real revolution over the last 25 years. The rapid spread of enhanced perioperative recovery pathways at first, and later of prehabilitation, has revolutionized the rules of management of patients scheduled for surgery. Despite this, the implementation of such strategies in many centers is suboptimal, and there are still many issues on which evidence is lacking.

The aim of this Special Issue is to serve as a forum to critically address the most relevant and, above all, some of the most unexplored aspects of perioperative medicine, from education, strategies for implementation, maintenance, possible areas for future improvement, and, most importantly, the long-term outcomes and patient-reported outcome measures.

Priority is given to high-quality, original studies, but well-designed and conducted systematic reviews (with or without a meta-analysis) are welcome. In summary, the Special Issue aims to increase clinicians’ knowledge of poorly explored areas of perioperative care, as well as to provide a balanced, sound, and evidence-based overview of the advances and potential perspectives in the field.

Dr. Carlos Cerdán Santacruz
Dr. Gianluca Pellino
Guest Editors

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Keywords

perioperative care
enhanced recovery after surgery
prehabilitation
minimally invasive surgery
patient-related outcome measures
colorectal surgery
general surgery
thoracic surgery
vascular surgery
optimal functional recovery

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Published Papers (6 papers)

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Research

13 pages, 1593 KiB

Open AccessArticle

Prehabilitation in Major Surgery: An Evaluation of Cost Savings in a Tertiary Hospital

by Natalia Mudarra-García, Fernando Roque-Rojas, Visitación Izquierdo-Izquierdo and Francisco Javier García-Sánchez

J. Clin. Med. 2025, 14(7), 2460; https://doi.org/10.3390/jcm14072460 - 3 Apr 2025

Viewed by 284

Abstract

(1) Background: Prehabilitation programs improve patients’ functional capacity before surgery by enhancing physical activity, nutrition, and psychological well-being, thereby reducing postoperative complications, hospital stays, and readmissions. We propose a centralized model led by an advanced practice nurse and internist to minimize consultations and reduce costs. (2) Methods: We studied 211 patients in a tertiary hospital in Madrid, with 135 enrolled in the centralized prehabilitation program and 76 in standard care (control). We compared complications, hospital stays, blood transfusions, and consultations, estimating costs using public pricing from Madrid’s healthcare authorities. (3) Results: The centralized model significantly reduced blood transfusions (p = 0.014), postoperative complications (p < 0.001), and hospital stays (p = 0.004), leading to annual savings of EUR 593,453.00. (4) Conclusions: A centralized surgical prehabilitation model decreases complications, hospital stays, readmissions, and consultations compared to standard care, significantly reducing healthcare costs. Full article

(This article belongs to the Special Issue Advances in Perioperative Care: Challenges and Perspectives in Enhanced Recovery after Surgery, Perioperative Optimization and Prehabilitation)

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13 pages, 2326 KiB

Open AccessArticle

Accuracy of the “Timed Up and Go” Test for Predicting Low Muscle Mass in a Preoperative Prehabilitation Program for Colorectal Cancer

by Leticia Pérez-Santiago, Luisa Paola Garzón-Hernández, José Martín-Arévalo, Vicente Pla-Martí, David Moro-Valdezate, David Casado-Rodrigo, Marina Riera-Cardona, Noelia Tarazona, Bianca Tabita Muresan, Ning Yun Wu Xiong, Alejandro Espí-Macías and Stephanie García-Botello

J. Clin. Med. 2025, 14(6), 2088; https://doi.org/10.3390/jcm14062088 - 19 Mar 2025

Viewed by 383

Abstract

Background: Preoperative sarcopenia is associated with increased morbidity and mortality in patients undergoing colorectal cancer (CRC) surgery. The assessment of muscle mass is crucial in identifying at-risk patients, but standard imaging methods like computed tomography (CT) scans require significant resources. Functional tests, such as the Timed Up and Go (TUG) test, may serve as simple and effective alternatives for sarcopenia screening. Objective: To evaluate the accuracy of the TUG test in predicting preoperative sarcopenia in patients scheduled for CRC surgery. Methods: A prospective observational study was conducted at a tertiary colorectal unit from January 2022 to June 2023. Patients underwent a prehabilitation assessment, including the TUG test, four weeks before surgery. Sarcopenia was diagnosed based on reduced muscle mass measured at the third lumbar vertebra on CT images. Statistical analyses included the sensitivity, specificity, and overall accuracy of the TUG test in predicting sarcopenia. Results: The study included 199 CRC patients (58.3% male, mean age 71.76 ± 10.42 years). Sarcopenia was present in 48.7% of patients. The mean TUG test length was 12.52 ± 7.95 s. A TUG test time of ≥10.19 s predicted sarcopenia with 70.1% sensitivity, 75.5% specificity, and an overall accuracy of 72.9% (95% CI = 0.660–0.790). Conclusions: The TUG test is a reliable, simple, and non-invasive tool for identifying sarcopenia in patients scheduled for colorectal cancer surgery, reducing reliance on CT scans. Early detection allows for timely interventions, improving surgical outcomes and overall patient prognosis. Full article

(This article belongs to the Special Issue Advances in Perioperative Care: Challenges and Perspectives in Enhanced Recovery after Surgery, Perioperative Optimization and Prehabilitation)

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10 pages, 758 KiB

Open AccessArticle

Prehabilitation in Frail Octogenarian and Nonagenarian Patients in Colorectal Cancer Surgery: Short- and Medium-Term Outcomes

by Raquel Ramírez-Martín, Coro Mauleón Ladrero, Jose Antonio Gazo Martínez, Victoria Déniz-González, Isabel Martín Maestre, Lucía Corral-Sastre, María Villajos-Guijarro, Rocío Menéndez-Colino, Isabel Pascual Miguelañez and Juan Ignacio González-Montalvo

J. Clin. Med. 2024, 13(20), 6114; https://doi.org/10.3390/jcm13206114 - 14 Oct 2024

Viewed by 1701

Abstract

Background: There is still limited evidence on the results of prehabilitation in very old frail patients. The aim of this study is to analyze the outcomes and course of octogenarian and nonagenarian patients undergoing prehabilitation before surgery for colorectal cancer (CRC). Methods: a prospective study was conducted in a tertiary hospital from 2018 to 2022. All patients diagnosed with CRC over 80 years old and proposed for surgery were included. A comprehensive geriatric assessment (CGA) for frailty detection was performed, and the therapeutic decision was taken by the multidisciplinary tumor committee. Prehabilitation led by the geriatric team was performed. The rate of medical and surgical complications, hospital stay, in-hospital mortality, and first-year mortality were recorded. Results: CRC surgery was proposed in 184 patients >80 years. After a multidisciplinary decision, surgery was performed on 126 (68.5%) patients, of whom 12 (0.5%) were nonagenarians. Fifty percent of octogenarians and 86% of nonagenarians were frail. Prehabilitation consisted of the following: adapted physical exercise (100%); oral nutritional supplementation (73.8%); anemia treatment (59.5%); delirium prevention (5.6%); antidepressant treatment (15.9%); vitamin D supplementation (21.4%); and pharmacological deprescription (38.1%). The post-surgical complication rate was low (4.3% surgical and 29.4% medical complications), and in-hospital mortality was very low (3.2%). Nonagenarian patients had a higher rate of complications compared to octogenarians (OR 4.0 (95% CI 1.13–14.12))—mainly heart failure (OR 4.68 (95% CI 1.21–18.09))—but there were no differences in hospital stay or first-year mortality. Conclusions: prehabilitation in very old patients with CRC surgery is possible and provides good results. Full article

(This article belongs to the Special Issue Advances in Perioperative Care: Challenges and Perspectives in Enhanced Recovery after Surgery, Perioperative Optimization and Prehabilitation)

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11 pages, 1642 KiB

Open AccessArticle

The Use of Fissios App© as a Complement to a Face-to-Face Respiratory Physiotherapy Program versus an Attendance-Only Face-to-Face Physiotherapy Program in Patients Scheduled for Thoracic Surgical Procedures Reduces the Risk of Developing Postoperative Pulmonary Complications—A Quasi-Experimental Study

by Carlos Alfredo Fraile Olivero, José Ramón Jarabo Sarceda, Elena Fernández Martín, Verónica Alen Villamayor, Joaquín Calatayud Gastardi, Ana María Gómez Martínez, Passio Santos, Pedro Daniel Arribas Manzanal, Carlos Cerdán Santacruz and Florentino Hernando Trancho

J. Clin. Med. 2023, 12(21), 6774; https://doi.org/10.3390/jcm12216774 - 26 Oct 2023

Cited by 1 | Viewed by 1655

Abstract

Postoperative pulmonary complications (PPCs) increase the hospital length of stay (LOS) and the cost of healthcare associated with surgical procedures. Strategies to reduce PPCs begin before surgery and continue in the postoperative period. Fissios App© is a smartphone application that contains perioperative medical advice and a structured respiratory physiotherapy program. The objective was to implement the use of this app in a group of patients scheduled for a thoracic surgical procedure and determine its efficacy in reducing PPCs. This was a quasi-experimental study in which all patients attended a face-to-face respiratory physiotherapy program, and the intervention group used Fissios App© as a complement. We prospectively recorded the postoperative evolution of both groups, analyzed the categorical differences and quantitative variables, and created a binary logistic regression model. We recruited 393 patients (131 intervention and 262 control). The intervention group had a lower incidence of PPCs (12.2% versus 24% in the control group, p = 0.006), a shorter LOS (a median of 3 days (IQR = 2–5) versus 4 days (IQR = 3–6, p = 0.001) in the control group), and a reduction in the risk of developing PPCs by 63.5% (OR: 0.365, 95% CI: 0.17–0.78). The use of Fissios App© improved the clinical outcomes after surgery and reduced the probability of developing PPCs. Full article

(This article belongs to the Special Issue Advances in Perioperative Care: Challenges and Perspectives in Enhanced Recovery after Surgery, Perioperative Optimization and Prehabilitation)

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12 pages, 715 KiB

Open AccessArticle

Utility of Cardiac Rehabilitation for Long-Term Outcomes in Patients with Hospital-Acquired Functional Decline after Cardiac Surgery: A Retrospective Study

by Kotaro Hirakawa, Atsuko Nakayama, Kentaro Hori, Reina Uewaki, Tomoki Shimokawa and Mitsuaki Isobe

J. Clin. Med. 2023, 12(12), 4123; https://doi.org/10.3390/jcm12124123 - 18 Jun 2023

Cited by 1 | Viewed by 2384

Abstract

Hospital-acquired functional decline is an important outcome that affects the long-term prognosis of patients after cardiac surgery. Phase II cardiac rehabilitation (CR) for outpatients is expected to improve prognosis; however, this is not clear in patients with hospital-acquired functional decline after cardiac surgery. Therefore, this study evaluated whether phase II CR improved the long-term prognosis of patients with hospital-acquired functional decline after cardiac surgery. This single-center, retrospective observational study included 2371 patients who required cardiac surgery. Hospital-acquired functional decline occurred in 377 patients (15.9%) after cardiac surgery. The mean follow-up period was 1219 ± 682 days in all patients, and there were 221 (9.3%) cases with major adverse cardiovascular events (MACE) after discharge during the follow-up period. The Kaplan–Meier survival curves indicated that hospital-acquired functional decline and non-phase II CR was associated with a higher incidence of MACE than other groups (log-rank, p < 0.001), additionally exhibiting prognosticating MACE in multivariate Cox regression analysis (HR, 1.59; 95% CI, 1.01–2.50; p = 0.047). Hospital-acquired functional decline after cardiac surgery and non-phase II CR were risk factors for MACE. The participation in phase II CR in patients with hospital-acquired functional decline after cardiac surgery could reduce the risk of MACE. Full article

(This article belongs to the Special Issue Advances in Perioperative Care: Challenges and Perspectives in Enhanced Recovery after Surgery, Perioperative Optimization and Prehabilitation)

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18 pages, 1365 KiB

Open AccessArticle

Multimodal Prehabilitation in Heart Transplant Recipients Improves Short-Term Post-Transplant Outcomes without Increasing Costs

by Manuel López-Baamonde, María José Arguis, Ricard Navarro-Ripoll, Elena Gimeno-Santos, Bárbara Romano-Andrioni, Marina Sisó, Silvia Terès-Bellès, Antonio López-Hernández, Adrià Burniol-García, Marta Farrero, Raquel Sebio-García, Elena Sandoval, María Sanz-de la Garza, Julián Librero, Ana García-Álvarez, María Ángeles Castel and Graciela Martínez-Pallí

J. Clin. Med. 2023, 12(11), 3724; https://doi.org/10.3390/jcm12113724 - 28 May 2023

Cited by 11 | Viewed by 8713

Abstract

(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) Methods: This single-center, ambispective cohort study included forty-six candidates for elective heart transplantation from 2017 to 2021 attending a multimodal prehabilitation program consisting of supervised exercise training, physical activity promotion, nutritional optimization, and psychological support. The postoperative course was compared to a control cohort consisting of patients transplanted from 2014 to 2017 and those contemporaneously not involved in prehabilitation. (3) Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, p < 0.001) and quality-of-life (Minnesota score 58 vs. 47, p = 0.046) after the program. No exercise-related events were registered. The prehabilitation cohort showed a lower rate and severity of postoperative complications (comprehensive complication index 37 vs. 31, p = 0.033), lower mechanical ventilation time (37 vs. 20 h, p = 0.032), ICU stay (7 vs. 5 days, p = 0.01), total hospitalization stay (23 vs. 18 days, p = 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p = 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs. (4) Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing. Full article

(This article belongs to the Special Issue Advances in Perioperative Care: Challenges and Perspectives in Enhanced Recovery after Surgery, Perioperative Optimization and Prehabilitation)

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