RESUMO
La prehabilitación tiene una concepción multimodal con tres pilares fundamentales: mejora en la condición física del paciente, optimización nutricional e intervención cognitiva para reducir el estrés y la ansiedad, además de otras medidas como la deshabituación tabáquica o la corrección de la anemia. El objetivo principal es la optimización del paciente durante el periodo de tiempo preoperatorio (diagnóstico-intervención) con la finalidad de mejorar la capacidad funcional y disminuir las complicaciones derivadas de la cirugía. Al igual que ocurre con los protocolos de rehabilitación multimodal, las acciones de los programas de prehabilitación tienen efectos sinérgicos, es decir, pequeños cambios que por sí solos no tienen transcendencia clínica pero que al sumarse producen una mejoría significativa en la evolución postoperatoria de los pacientes. Aunque se requieren más estudios que evalúen el impacto concreto de estos programas en poblaciones de pacientes con diversas patologías, intervenciones y distintos factores de riesgo, se hace necesaria su implementación progresiva en la práctica clínica habitual de nuestros pacientes. El objetivo de esta revisión narrativa es evaluar la literatura disponible sobre la prehabilitación en cirugía, haciendo especial hincapié en las estrategias actualmente establecidas, así como en las lagunas de conocimiento actuales y futuros focos de investigación
Prehabilitation has a multimodal conception based on three fundamental pillars: improvement of the patient's physical condition, nutritional optimization and cognitive intervention to reduce stress and anxiety, as well as other measures such as smoking cessation and correction of anemia. The aim of prehabilitation programs is to optimize the patient from the moment of diagnosis until the surgical intervention in order to reduce postoperative complications. As in the case of multimodal rehabilitation protocols, the actions of prehabilitation programs have synergistic effects, that is, small changes that, by themselves, do not have clinical significance but when added up, they produce a significant improvement in the postoperative evolution of patients. Although more studies are required to evaluate the impact of these programs on patients groups with different pathologies, interventions and risk factors, their progressive implementation is necessary in the daily clinical practice of our patients. The objective of this narrative review is to evaluate the available evidence about prehabilitation in surgery, focusing on current established strategies, knowledge gaps and future research
Assuntos
Humanos , Complicações Pós-Operatórias/prevenção & controle , Anemia/terapia , Ansiedade/prevenção & controle , Composição Corporal , Exercício Físico , Reconciliação de Medicamentos , Atenção Plena , Estado Nutricional , Condicionamento Físico Humano , Testes Psicológicos , Abandono do Hábito de Fumar , Estresse Fisiológico/fisiologiaRESUMO
Prehabilitation has a multimodal conception based on three fundamental pillars: improvement of the patient's physical condition, nutritional optimization and cognitive intervention to reduce stress and anxiety, as well as other measures such as smoking cessation and correction of anemia. The aim of prehabilitation programs is to optimize the patient from the moment of diagnosis until the surgical intervention in order to reduce postoperative complications. As in the case of multimodal rehabilitation protocols, the actions of prehabilitation programs have synergistic effects, that is, small changes that, by themselves, do not have clinical significance but when added up, they produce a significant improvement in the postoperative evolution of patients. Although more studies are required to evaluate the impact of these programs on patients groups with different pathologies, interventions and risk factors, their progressive implementation is necessary in the daily clinical practice of our patients. The objective of this narrative review is to evaluate the available evidence about prehabilitation in surgery, focusing on current established strategies, knowledge gaps and future research.
