The Use of Surgical Prehabilitation to Augment Enhanced Recovery Protocols in Gynecologic Oncology
November 27, 2021- 00:00Hello my name is Stephanie Salas and
- 00:02this is my thesis presentation on
- 00:04the use of multimodal prehabilitation
- 00:06to augment enhanced recovery
- 00:08protocols in gynecological oncology.
- 00:11So surgery presents a major
- 00:12stress to the body,
- 00:14mobilizing energy reserves,
- 00:15increasing protein catabolism and
- 00:17promoting skeletal muscle wasting in
- 00:19oncology patients often present with
- 00:21diminished preoperative functional
- 00:23reserve with less ability to withstand
- 00:25this major physiologic perturb
- 00:26and putting them at a higher risk
- 00:29of postoperative complications.
- 00:30Prolonged hospital stays.
- 00:31And a reduction of their
- 00:33baseline functional status.
- 00:35Enhanced recovery protocols and
- 00:36gynecological oncology have been
- 00:38incorporated in recent years into
- 00:40perioperative management with
- 00:42effective improvement in morbidity
- 00:43and mortality outcomes,
- 00:45and these are a group of evidence
- 00:47based protocols that address
- 00:48mitigating surgical stress.
- 00:50Maintenance of physiologic function
- 00:52and early mobility after surgery and
- 00:54untouched window of time remains
- 00:56though in the interim between
- 00:58diagnosis and surgery that can be
- 01:00used to further enhance recovery.
- 01:02This is where the concept
- 01:05of prehabilitation comes in.
- 01:07It has been suggested as a way to
- 01:09optimize physiologic resilience by
- 01:11increasing skeletal muscle mass,
- 01:13promoting adequate protein intake,
- 01:14and decreasing anxiety levels
- 01:16prior to surgery.
- 01:17It's been studied in colorectal surgery
- 01:19and has shown promising results,
- 01:20but similar studies are still lacking
- 01:22in the field of gynecological oncology.
- 01:25In designing this thesis,
- 01:26we hypothesize that women undergoing
- 01:28hysterectomy for known or suspected
- 01:30gynecological ignan see who participate
- 01:32in a multimodal prehabilitation and in
- 01:35addition to enhanced recovery protocols,
- 01:37would have a statistically significant
- 01:39improvement in their functional
- 01:41status from baseline in comparison
- 01:43to control subjects participating in
- 01:45enhanced recovery protocols alone.
- 01:46And we measured functional status
- 01:48as our primary outcome using the
- 01:50six minute walk test and used
- 01:52complication rates and quality
- 01:53of life as secondary outcomes.
- 01:55The pre Abilitation intervention
- 01:57includes 150 minutes of moderate
- 01:59intensity aerobic exercise per week
- 02:01protein intake goals of 1.2 to 1.5 grams.
- 02:04Per kilogram per day and 10 minutes of
- 02:07guided stress reduction meditations daily,
- 02:09Fitbit devices were proposed as a
- 02:11means of monitoring adherence to
- 02:13each leg of the intervention as well
- 02:15as to provide motivation to the
- 02:17patients and this use of Fitbits
- 02:18was a strength of the design as the
- 02:21use of wearable exercise trackers.
- 02:23In pre habilitation studies is fairly
- 02:25novel and they allow for adherence
- 02:27to be automatically tracked in one location.
- 02:30One limitation of our design was
- 02:31the short time period available for
- 02:33an intervention.
- 02:34As in many cases,
- 02:36the urgency of surgery limits the time
- 02:38after diagnosis to as little as two weeks.
- 02:41Overall,
- 02:42the Hasting returned to baseline from
- 02:44pre Abilitation would allow patients
- 02:46to receive follow-up treatments
- 02:48and chemotherapy without delay,
- 02:50and on a broader scale,
- 02:51pre abilitation is an opportunity
- 02:53to educate patients on how to have
- 02:55an active role in their cancer
- 02:56management and protect prioritize
- 02:58a healthy lifestyle from the very
- 03:00beginning of the care continuum.
- 03:02Thank you for listening.