La recuperación empieza antes de la Cirugía
Palabras clave:
CIRUGÍA, PERIODO PERIOPERATORIO, ASISTENCIA POSOPERATORIA, RECUPERACIÓN MEJORADA POSTQUIRÚRGICA
Resumen
Un paciente que se somete a una cirugía mayor se enfrenta a un factor estresante importante. Dependiendo de la magnitud de la cirugía, la respuesta al estrés quirúrgico puede alterar los procesos metabólicos y la homeostasis. A pesar de cualquier complicación quirúrgica, se ha demostrado que las cirugías mayores reducen la capacidad fisiológica y funcional del individuo. Al mismo tiempo, la inactividad y el reposo en cama pueden inducir una rápida atrofia muscular. Estas consecuencias se asocian a perores resultados quirúrgicos. La pre-habilitación quirúrgica es un enfoque innovador en el campo de la medicina que busca mejorar los resultados de los pacientes sometidos a cirugía mediante la optimización de su estado físico y mental antes de la intervención quirúrgica. A diferencia de la rehabilitación, que se lleva a cabo después de la cirugía para ayudar en la recuperación, la pre-habilitación se realiza antes de la operación con el objetivo de preparar al paciente de manera integral. El objetivo principal de la pre-habilitación quirúrgica es minimizar los efectos negativos de la cirugía, acelerar la recuperación y mejorar la calidad de vida después de la intervención. Para lograr esto, se implementan diferentes intervenciones multidisciplinarias que abordan aspectos físicos, emocionales y nutricionales del paciente. En este artículo, exploramos el concepto de prehabilitación como una herramienta eficaz para mejorar los resultados de las intervenciones quirúrgicas. Discutimos diferentes estrategias y enfoques que pueden implementarse como parte de la prehabilitación quirúrgica, con el objetivo de minimizar complicaciones, acelerar la recuperación y mejorar la calidad de vida postoperatoria. Además, examinamos la evidencia actual disponible y resaltamos la necesidad de futuras investigaciones para validar y ampliar el conocimiento sobre esta prometedora área en la medicina perioperatoria.
Citas
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2) Martin D, Mantziari S, Demartines N, Hübner M; ESA Study Group. Defining major surgery: a delphi consensus among European Surgical Association (ESA) members. World J Surg 2020; 44(7):2211-19. doi: 10.1007/s00268-020-05476-4.
3) Onwochei DN, Fabes J, Walker D, Kumar G, Moonesinghe SR. Critical care after major surgery: a systematic review of risk factors for unplanned admission. Anaesthesia 2020; 75(Suppl 1):e62-e74. doi: 10.1111/anae.14793.
4) Kahan BC, Koulenti D, Arvaniti K, Beavis V, Campbell D, Chan M, et al. Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Med 2017; 43(7):971-9. doi: 10.1007/s00134-016-4633-8.
5) Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med 2018; 378(24):2263-74. doi: 10.1056/NEJMoa1801601.
6) Ohbe H, Matsui H, Kumazawa R, Yasunaga H. Postoperative ICU admission following major elective surgery: a nationwide inpatient database study. Eur J Anaesthesiol 2022; 39(5):436-44. doi: 10.1097/EJA.0000000000001612.
7) Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet 2012; 22(380):1059-65. doi: 10.1016/S0140-6736(12)61148-9.
8) International Surgical Outcomes Study Group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth 2016; 117(5):601-9. doi: 10.1093/bja/aew316.
9) Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A, et al. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care 2006; 10(3):R81. doi: 10.1186/cc4928.
10) Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 2005; 242(3):326-41. doi: 10.1097/01.sla.0000179621.33268.83.
11) Hughes M, Chong J, Harrison E, Wigmore S. Short-term outcomes after liver resection for malignant and benign disease in the age of ERAS. HPB (Oxford) 2016; 18(2):177-82. doi: 10. doi: 1016/j.hpb.2015.10.011.
12) McCulloch P, Ward J, Tekkis PP. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ 2003; 327(7425):1192-7. doi: 10.1136/bmj.327.7425.1192.
13) Okunrintemi V, Gani F, Pawlik T. National trends in postoperative outcomes and cost comparing minimally invasive versus open liver and pancreatic surgery. J Gastrointest Surg 2016; 20(11):1836-43. doi: 10.1007/s11605-016-3267-z.
14) Cusack B, Buggy DJ. Anaesthesia, analgesia, and the surgical stress response. BJA Educ 2020; 20(9):321-8. doi: 10.1016/j.bjae.2020.04.006.
15) McIsaac DI, Gill M, Boland L, Hutton B, Branje K, Shaw J, et al. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth 2022; 128(2):244-57. doi: 10.1016/j.bja.2021.11.014.
16) Voiriot G, Oualha M, Pierre A, Salmon-Gandonnière C, Gaudet A, Jouan Y, et al. Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges. Ann Intensive Care 2022; 12(1):58. doi 10.1186/s13613-022-01038-0.
17) Hardiman SC, Villan Villan YF, Conway JM, Sheehan KJ, Sobolev B. Factors affecting mortality after coronary bypass surgery: a scoping review. J Cardiothorac Surg 2022; 17(1):45. doi 10.1186/s13019-022-01784-z.
18) Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005; 24(3):466-77. doi: 10.1016/j.clnu.2005.02.002.
19) Ljungqvist O, de Boer HD, Balfour A, Fawcett WJ, Lobo DN, Nelson G, et al. Opportunities and challenges for the next phase of enhanced recovery after surgery: a review. JAMA Surg 2021; 156(8):775-84. doi: 10.1001/jamasurg.2021.0586.
20) Keller DS, Lee P. Debunking enhanced recovery protocols in colorectal surgery: minimal requirements for maximum benefit. En: Sylla P, Kaiser AM, Popowich D, eds. The SAGES Manual of Colorectal Surgery. Cham: Springer, 2020:87-102. doi: 10.1007/978-3-030-24812-3_7.
21) Maessen J, Dejong C, Hausel J, Nygren J, Lassen K, Andersen J, et al. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 2007; 94(2):224-31. doi: 10.1002/bjs.5468.
22) Gustafsson U, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J. Adherence to enhanced recovery after surgery study group. adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 2011; 146(5):571-7. doi: 10.1001/archsurg.2010.309.
23) Wolk S, Distler M, Müssle B, Söthje S, Weitz J, Welsch T. Adherence to ERAS elements in major visceral surgery-an observational pilot study. Langenbecks Arch Surg 2016; 401(3): 349-56. doi: 10.1007/s00423-016-1407-2.
24) Roulin D, Melloul E, Wellg B, Izbicki J, Vrochides D, Adham M, et al. Feasibility of an enhanced recovery protocol for elective pancreatoduodenectomy: a Multicenter International Cohort Study. World J Surg 2020; 44(8):2761-9. doi: 10.1007/s00268-020-05499-x.
25) Seow-En I, Wu J, Yang L, Tan J, Seah A, Foo F, et al. Results of a colorectal enhanced recovery after surgery (ERAS) programme and a qualitative analysis of healthcare workers' perspectives. Asian J Surg 2021; 44(1):307-12. doi: 10.1016/j.asjsur.2020.07.020.
26) Kitahata Y, Hirono S, Kawai M, Okada K, Miyazawa M, Shimizu A, et al. Intensive perioperative rehabilitation improves surgical outcomes after pancreaticoduodenectomy. Langenbecks Arch Surg 2018; 403(6):711-8. doi: 10.1007/s00423-018-1710-1.
27) Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis 2012; 14(8):1009-13. doi: 10.1111/j.1463-1318.2011. 02855.x.
28) Gillis C, Ljungqvist O, Carli F. Prehabilitation, enhanced recovery after surgery, or both? A narrative review. Br J Anaesth 2022; 128(3):434-48. doi: 10.1016/j.bja.2021.12.007.
29) Soeters PB, Grimble RF. Dangers, and benefits of the cytokine mediated response to injury and infection. Clin Nutr 2009; 28(8):583-96. doi: 10.1016/j.clnu.2009.05.014.
30) English KL, Paddon-Jones D. Protecting muscle mass and function in older adults during bed rest. Curr Opin Clin Nutr Metab Care 2010; 13:34-9. doi: 10.1097/MCO.0b013e328333aa66.
31) Pearse R, Holt P, Grocott M. Managing perioperative risk in patients undergoing elective non-cardiac surgery. BMJ 2011; 343:d5759. doi: 10.1136/bmj.d5759.
32) Pearse RM, Ackland GL. Perioperative fluid therapy. BMJ 2012; 344:e2865. doi: 10.1136/bmj.e2865.
33) Huang D, Wang S, Zhuang C, Zheng B, Lu J, Chen F, et al. Sarcopenia, as defined by low muscle mass, strength and physical performance, predicts complications after surgery for colorectal cancer. Colorectal Dis 2015; 17(11):O256-64. doi: 10.1111/codi.13067.
34) Hua H, Xu X, Tang Y, Ren Z, Xu Q, Chen L. Effect of sarcopenia on clinical outcomes following digestive carcinoma surgery: a meta-analysis. Support Care Cancer 2019; 27(7):2385-94. doi: 10.1007/s00520-019-04767-4.
35) Pipek L, Baptista C, Nascimento R, Taba J, Suzuki M, do Nascimento F, et al. The impact of properly diagnosed sarcopenia on postoperative outcomes after gastrointestinal surgery: a systematic review and meta-analysis. PLoS One 2020; 15(8):e0237740. doi: 10.1371/journal.pone.0237740.
36) Antoniou G, Rojoa D, Antoniou S, Alfahad A, Torella F, Juszczak M. Effect of low skeletal muscle mass on post-operative survival of patients with abdominal aortic aneurysm: a prognostic factor review and meta-analysis of time-to-event data. Eur J Vasc Endovasc Surg 2019; 58(2):190-8. doi: 10.1016/j.ejvs.2019.03.020.
37) Choi M, Yoon S, Lee K, Song M, Lee I, Lee M, et al. Preoperative sarcopenia and post-operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer. J Cachexia Sarcopenia Muscle 2018; 9(2):326-34. doi: 10.1002/jcsm.12274.
38) Gillies MA, Sander M, Shaw A, Wijeysundera DN, Myburgh J, Aldecoa C, et al. Current research priorities in perioperative intensive care medicine. Intensive Care Med 2017; 43(9):1173-86. doi: 10.1007/s00134-017-4848-3.
39) Scheede-Bergdahl C, Minnella EM, Carli F. Multi-modal prehabilitation: addressing the why, when, what, how, who and where next?. Anaesthesia 2019; 74(Suppl 1):20-6. doi: 10.1111/anae.14505.
40) Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 2007; 116(3):329-43. doi: 10.1161/CIRCULATIONAHA.106.184461.
41) Gillis C, Davies SJ, Carli F, Wischmeyer PE, Wootton SA, Jackson AA, et al. Current landscape of nutrition within prehabilitation oncology research: a scoping review. Front Nutr 2021; 8:644723. doi: 10.3389/fnut.2021.644723.
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Publicado
2023-06-29
Cómo citar
1.
López P, Moreira E, Olano E, Silva L. La recuperación empieza antes de la Cirugía. Rev. Méd. Urug. [Internet]. 29 de junio de 2023 [citado 28 de abril de 2024];39(2):e501. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/1034
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