The next step: optimizing preoperative functional fitness and nutritional intervention.

摘要

I read with great interest the recent case report by Dr. Franco Carli et al. describing the prehabilitation and surgical outcome of a frail 88-yr-old patient who underwent a robotic-assisted hysterectomy. Significant factors in this case included (i) existing mild cognitive impairment; (ii) physical frailty requiring use of a walker for ambulation, only 24% of normal for age with six-minute walk test; (iii) documentation of two previous episodes of postoperative cognitive dysfunction (POCD); and (iv) previous myocardial infarction with ejection fraction > 60%. In this case, a three-week preoperative intervention consisted of nine home visits by a kinesiologist and two visits each by a nutritionist and a psychologist. This intervention was reported to have contributed to an absence of POCD, a favourable and brief (two-day) postoperative hospital length of stay (LOS), and continued improvement of the patient's physical and psychological status at eight weeks postoperatively.