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Background: Intensive care unit (ICU) protein benchmarks are based on mortality and morbidity; whether these targets also support functional recovery is unknown. We assessed whether different protein doses influenced patients' functional capacity, measured by the Chelsea Physical Assessment score (CPAx). Methods: Single‐center retrospective cohort study on ICU survivors with length of stay ≥7 days admitted between October 2014 and September 2020. Eligible patients were divided according to protein intake (g/kg/day): low (<0.8), medium (0.8–1.19), high (1.2–1.5), and very high (>1.5). Protein dose effect on CPAx was assessed at ICU discharge with analysis of covariance adjusting for age, illness severity, hospital length of stay before ICU admission, time to start nutrition support, and mechanical ventilation duration. We also investigated effect modification by energy intake and nutrition status. Results: Enrolled patients (n = 531) were similar for age, nutrition status, and illness severity across groups. CPAxs were nonlinearly associated with protein doses and similar among low, medium, and very high groups. The CPAx for the high group was statistically different (P = 0.014), indicating that the data of three groups could be pooled. Mean CPAx difference remained statistically significant after adjusting for confounding variables (3.9 ± 1.8, P = 0.029 in the four‐group model, and 2.7 ± 0.9, P = 0.003 in the pooled two‐group model). Energy intake was equivalent between groups and did not modify CPAx. The high group had superior CPAx in both well‐nourished and malnourished patients, indicating nutrition status was not an effect modifier. Conclusion: Protein dose 1.2–1.5 g/kg/day was associated with superior functional capacity at ICU discharge compared with other doses. Neither energy intake nor nutrition status modified functional capacity across groups; therefore, the results appear to be influenced by 1.2–1.5 g/kg/day. [ABSTRACT FROM AUTHOR]

Background: Enhanced Recovery After Surgery (ERAS) and prehabilitation programs are evidence-based and patient-focused, yet meaningful patient input could further enhance these interventions to produce superior patient outcomes and patient experiences. We conducted a qualitative study with patients who had undergone colorectal surgery under ERAS care to determine how they prepared for surgery, their views on prehabilitation and how prehabilitation could be delivered to best meet patient needs. Methods: We conducted semistructured interviews with adult patients who had undergone colorectal surgery under ERAS care within 3 months after surgery. Patients were enrolled between April 2018 and June 2019 through purposive sampling from 1 hospital in Alberta. The interview transcripts were analyzed independently by a researcher and a trained patient-researcher using inductive thematic analysis. Results: Twenty patients were interviewed. Three main themes were identified. First, waiting for surgery: patients described fear, anxiety, isolation and deterioration of their mental and physical states as they waited passively for surgery. Second, preparing would have been better than just waiting: patients perceived that a prehabilitation program could prepare them for their operation if it addressed their emotional and physical needs, provided personalized support, offered home strategies, involved family and included surgical expectations (both what to expect and what is expected of them). Third, partnering with patients: preoperative preparation should occur on a continuum that meets patients where they are at and in a partnership that respects patients' expertise and desired level of engagement. Conclusion: We identified several patient priorities for the preoperative period. Integrating these priorities within ERAS and prehabilitative programs could improve patient satisfaction, experiences and outcomes. Actively engaging patients in their care might alleviate some of the anxiety and fear associated with waiting passively for surgery. Contexte : Les protocoles de récupération optimisée après une chirurgie (ERAS, pour Enhanced Recovery After Surgery) et les programmes de préadaptation se fondent sur des données probantes et sont centrés sur les patients et pourtant, une plus grande contribution de ces derniers permettrait d'améliorer ces interventions et donneraient lieu à des résultats et des expériences plus satisfaisants pour les patients. Nous avons procédé à une étude qualitative auprès de patients ayant subi une chirurgie colorectale avec protocole ERAS afin de savoir comment ils se sont préparés à la chirurgie, quel est leur point de vue sur la préadaptation et en quoi cette dernière pourrait mieux répondre à leurs besoins. Méthodes : Nous avons réalisé des entrevues semi-structurées auprès de patients adultes ayant subi une chirurgie colorectale avec protocole ERAS dans les 3 mois suivant leur chirurgie. Les patients ont été inscrits dans un hôpital albertain entre avril 2018 et juin 2019 par le biais d'un échantillonnage dirigé. Les transcriptions des entrevues ont fait l'objet d'une analyse thématique inductive indépendante par une chercheuse et une patientechercheuse dûment formée. Résultats : Vingt patients ont été interrogés. Trois grands thèmes ont été dégagés : 1) en attente de la chirurgie (les patients ont fait état de peur, d'anxiété, d'un sentiment d'isolement et d'une détérioration de leur état de santé mentale et physique durant l'attente passive de la chirurgie); 2) une préparation leur a semblé préférable à une simple attente (les patients ont senti qu'un programme de préadaptation les aiderait à se préparer à leur chirurgie s'il tenait compte de leurs besoins émotionnels et physiques, s'il fournissait un soutien personnalisé, des stratégies de soutien à domicile, s'il impliquait les familles et incluait une discussion sur les attentes vis-à-vis de la chirurgie); et 3) partenariat avec les patients (la préparation devrait se dérouler selon un continuum adapté à la situation de chaque patient sous la forme d'un partenariat qui respecte son expertise et son niveau d'engagement). Conclusion : Nous avons identifié plusieurs priorités pour les patients durant l'étape préopératoire. Intégrer ces priorités dans les protocoles ERAS et les programmes de préadaptation pourrait améliorer la satisfaction, les expériences et les résultats chez les patients. Faire participer activement les patients à leurs soins pourrait contribuer à soulager une part de l'anxiété et de la peur associées à l'attente passive de la chirurgie., The Enhanced Recovery After Surgery (ERAS) program for colorectal surgery involves the implementation and evaluation of more than 20 multimodal elements of perioperative care. (1) Collectively, these elements standardize surgical [...]

Mounting evidence suggests that recovery begins before the surgical incision. The presurgery phase of recovery, namely the preparation for optimal surgical recovery, can be reinforced with prehabilitation. Prehabilitation is the approach of enhancing the functional capacity of the individual to enable them to withstand a stressful event. With this narrative review, we apply the Wilson and Cleary conceptual model of patient outcomes to specify the complex and integrative relationship of health factors that limit functional capacity before surgery. To have the greatest impact on patient outcomes, prehabilitation programs require individualised and coordinated care from medical, nutritional, psychosocial and exercise services. Key points: 1.Many biological and physiological factors influence functional capacity.2.Some of the biological and physiological factors that limit function cannot be corrected with exercise alone.3.Prehabilitation programs that identify and address the root cause(s) for poor functional capacity with multimodal treatment may produce positive outcomes more consistently. [ABSTRACT FROM AUTHOR]

Preoperative nutrition status is an important determinant of surgical outcomes, yet malnutrition assessment is not integrated into all surgical pathways. Given its importance and the high prevalence of malnutrition in patients undergoing surgical procedures, preoperative nutrition screening, assessment, and intervention are needed to improve postoperative outcomes. This narrative review discusses novel methods to assess malnutrition and frailty in the surgical patient. The Global Leadership Initiative for Malnutrition (GLIM) criteria are increasingly used in surgical settings although further spread and implementation are strongly encouraged to help standardize the diagnosis of malnutrition. The use of body composition (ie, reduced muscle mass) as a phenotypic criterion in GLIM may lead to a greater number of patients identified as having malnutrition, which may otherwise be undetected if screened by other diagnostic tools. Skeletal muscle loss is a defining criterion of malnutrition and frailty. Novel direct and indirect approaches to assess muscle mass in clinical settings may facilitate the identification of patients with or at risk for malnutrition. Selected imaging techniques have the additional advantage of identifying myosteatosis (an independent predictor of morbidity and mortality for surgical patients). Feasible pathways for screening and assessing frailty exist and may determine the cost/benefit of surgery, long‐term independence and productivity, and the value of undertaking targeted interventions. Finally, the evaluation of nutrition risk and status is essential to predict and mitigate surgical outcomes. Nascent to novel approaches are the future of objectively identifying patients at perioperative nutrition risk and guiding therapy toward optimal perioperative standards of care. [ABSTRACT FROM AUTHOR]