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Canadian Journal of Cardiology

Prehabilitation for Vascular Surgery Patients: Challenges and Opportunities

Published:February 28, 2022DOI:https://doi.org/10.1016/j.cjca.2022.02.017

      Abstract

      Global demand for major surgery is rising as a consequence of a growing ageing population, and clinically applicable approaches to perioperative risk reduction have never been more needed. Prehabilitation aims to optimise aerobic capacity and address modifiable risk factors before surgery to improve postoperative outcomes. Given the inherently high-risk nature of vascular surgery and the frequently high-acuity frail vascular surgical population, the potential to introduce an intervention into the surgical pathway that may reduce postoperative complications cannot be overlooked. The aim of this review is to examine the current evidence base for prehabilitation in patients awaiting vascular surgery, and to summarise the potential benefits, pitfalls, and practicalities of this emerging perioperative intervention. There is a paucity of high-quality research specifically aimed at prehabilitation for patients undergoing vascular surgery, both peripheral and aortic, making it difficult to draw definitive conclusions upon which to base a change in practice. Currently, evidence is taken from small, often single-centre, heterogeneous studies that vary significantly from each other, meaning that the optimal exercise regimen for patients awaiting vascular surgery has yet to be defined. Establishing the impact of prehabilitation on outcomes for vascular patients is important as the effectiveness of preoperative exercise training is likely to vary between surgical interventions and patient populations. However, extrapolation from other cohorts is possible and indeed forms the basis of many current prehabilitation programmes. Given the success of prehabilitation in other surgical groups, it has potential to become an important future research target for patients awaiting vascular surgery.

      Résumé

      La demande mondiale en matière de chirurgies lourdes augmente en raison du vieillissement de la population, et le besoin en outils de réduction des risques peropératoires pouvant trouver une application sur le plan clinique n’a jamais été aussi grand. La préadaptation vise à optimiser la capacité respiratoire et à atténuer les facteurs de risque modifiables des patients avant l’intervention chirurgicale afin d’améliorer les résultats postopératoires. En raison du risque intrinsèquement élevé des interventions chirurgicales vasculaires et des soins aigus souvent requis par la santé fragile des patients concernés, il ne faut pas négliger la possibilité d’intégrer dans le parcours chirurgical une intervention susceptible de réduire les complications postopératoires. L’objectif de cette revue est d’examiner les données probantes actuelles à l’appui de la préadaptation chez les patients en attente d’une chirurgie vasculaire, et de résumer les éventuels avantages, pièges et aspects pratiques de ce nouveau mode de préparation du patient. Il existe peu d’études de bonne qualité portant spécifiquement sur la préadaptation des patients devant subir une intervention chirurgicale vasculaire, qu’elle soit périphérique ou aortique, ce qui ne permet pas de tirer aisément des conclusions définitives étayant une modification de la pratique. Étant donné que les données probantes actuelles proviennent de petites études hétérogènes, souvent monocentriques et considérablement différentes les unes des autres, le régime d’exercice optimal des patients en attente d’une chirurgie vasculaire reste à définir. Il est important d’établir l’effet de la préadaptation sur les résultats des patients devant subir une intervention chirurgicale vasculaire, car l’efficacité du programme d’exercices préopératoire est susceptible de varier selon les interventions chirurgicales et les patients. L’extrapolation des résultats obtenus dans d’autres cohortes est néanmoins possible et constitue en fait le fondement de nombreux programmes de préadaptation actuels. Étant donné le succès de la préadaptation dans d’autres domaines chirurgicaux, elle pourrait devenir un sujet de recherche pertinent pour les patients en attente d’une chirurgie vasculaire.
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