Effect of perioperative rehabilitation exercise on postoperative outcomes in patients aged ≥65 years undergoing gastrointestinal surgery: A multicenter randomized controlled trial

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-11-02 DOI:10.1016/j.jclinane.2024.111670

Xuecai Lv MD , Aisheng Hou MD , Shiyi Han MD , Jiangbei Cao MD, PhD , Jingsheng Lou MD, PhD , Hao Li MD, PhD , Su Min MD, PhD , Hongyu Tan MD, PhD , Shuo Li MD, PhD , Feng Lv MD, PhD , Zhikang Zhou BD , Menglin Chi BD , Hong Zhang MD, PhD , Yanhong Liu MD, PhD , Weidong Mi MD, PhD

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Abstract

Study objectives

This study aimed to assess the effect of perioperative rehabilitation exercise, initiated shortly after hospital admission, on postoperative outcomes in elderly patients.

Design

A prospective, multicenter, randomized, controlled, open-label, and assessor-blinded clinical trial.

Setting

Hospital wards.

Patients

Elderly patients (≥65 years, n = 160) scheduled for gastrointestinal surgery between June 2021 and November 2022 were enrolled and randomly assigned to the intervention or control group.

Interventions

Patients were divided into two groups base on whether they had received a specific type of exercise program initiated after hospital admission and continued until 30 days after surgery.

Measurements

The primary outcome was the Comprehensive Complications Index (CCI) measured at 30 days after surgery. Secondary outcomes were the rate of complications, number of complications, patient satisfaction, hospital readmission, postoperative length of stay, gastrointestinal function recovery, postoperative quality of life and psychological status. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted.

Main results

ITT analysis showed a significantly lower 30-day CCI in the intervention group (β: -6.31; 95 % Confidence Interval [CI], −11.26 to −1.37, P = 0.013). Compared to controls, the intervention group had a decreased rate of hospital readmission (Odds Ratio: 0.00; 95 % CI, 0.00 to 0.32, P = 0.022), less number of complications (β: -0.57; 95 % CI, −1.03 to −0.11, P = 0.016), as well as lower rate of postoperative anxiety (β: -0.74; 95 % CI, −1.42 to −0.06, P = 0.033) and depression scores (β: -1.13; 95 % CI, −0.97 to −1.30, P = 0.008). Additionally, the intervention group reported higher satisfaction (β: 0.98; 95 % CI, 0.33 to 1.64, P = 0.004) and Euro quality of life-Visual Analogue Scale scores (β: 8.88; 95 % CI, 2.48 to 15.28, P = 0.007). Similar results were found in the PP analysis.

Conclusion

Perioperative rehabilitation exercise has a positive impact on postoperative complications, quality of life and psychological well-being in elderly patients undergoing gastrointestinal surgery, even when implemented after hospital admission.

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围手术期康复锻炼对接受胃肠道手术的≥65 岁患者术后效果的影响：多中心随机对照试验。

研究目的本研究旨在评估入院后不久开始的围手术期康复锻炼对老年患者术后效果的影响：前瞻性、多中心、随机对照、开放标签和评估者盲法临床试验：患者患者：2021年6月至2022年11月期间计划接受胃肠道手术的老年患者（≥65岁，n = 160）：干预措施：根据患者是否在入院后接受了特定类型的锻炼计划并持续到术后 30 天，将患者分为两组：主要结果是术后30天的综合并发症指数（CCI）。次要结果为并发症发生率、并发症数量、患者满意度、再入院率、术后住院时间、胃肠功能恢复情况、术后生活质量和心理状态。进行了意向治疗（ITT）和按协议（PP）分析：ITT分析显示，干预组的30天CCI明显降低（β：-6.31；95%置信区间[CI]，-11.26至-1.37，P = 0.013）。与对照组相比，干预组的再入院率降低（Odds Ratio：0.00；95 % CI，0.00 至 0.32，P = 0.022），并发症数量减少（β：-0.57；95 % CI，-1.03至-0.11，P = 0.016），术后焦虑率较低（β：-0.74；95 % CI，-1.42至-0.06，P = 0.033），抑郁评分较低（β：-1.13；95 % CI，-0.97至-1.30，P = 0.008）。此外，干预组的满意度更高（β：0.98；95 % CI，0.33 至 1.64，P = 0.004），欧洲生活质量-视觉模拟量表评分更高（β：8.88；95 % CI，2.48 至 15.28，P = 0.007）。结论：围手术期康复锻炼对患者的康复有积极作用：围手术期康复锻炼对接受胃肠道手术的老年患者的术后并发症、生活质量和心理健康有积极影响，即使是在入院后实施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.