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Predictive modelling for optimization of preoperative care in multimorbid patients undergoing major surgery

Anael Barberan-Garcia, Mar Montane-Muntane, Alicia Hervas, Pilar Hurtado, Betina Campero, Bárbara Romano-Andrioni, Silvia Teres-Belles, Elena Gimeno-Santos, Josep Roca, Graciela Martinez-Palli
European Respiratory Journal 2020 56: 2936; DOI: 10.1183/13993003.congress-2020.2936
Anael Barberan-Garcia
1Hospital Clínic de Barcelona - IDIBAPS, Barcelona, Spain
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  • For correspondence: anaelbg@gmail.com
Mar Montane-Muntane
2Hospital Clínic de Barcelona, Barcelona, Spain
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Alicia Hervas
2Hospital Clínic de Barcelona, Barcelona, Spain
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Pilar Hurtado
3Mensalus Fundation, Barcelona, Spain
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Betina Campero
2Hospital Clínic de Barcelona, Barcelona, Spain
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Bárbara Romano-Andrioni
2Hospital Clínic de Barcelona, Barcelona, Spain
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Silvia Teres-Belles
2Hospital Clínic de Barcelona, Barcelona, Spain
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Elena Gimeno-Santos
1Hospital Clínic de Barcelona - IDIBAPS, Barcelona, Spain
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Josep Roca
1Hospital Clínic de Barcelona - IDIBAPS, Barcelona, Spain
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Graciela Martinez-Palli
1Hospital Clínic de Barcelona - IDIBAPS, Barcelona, Spain
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Abstract

Introduction: Preoperative optimization programs are effective interventions to improve postoperative outcomes in patients undergoing major surgery. However, customization of these programs to multimorbid patients’ is an unmet need. The current study aims to identify factors associated to program completion, and to postoperative complications, in multimorbid patients undergoing major surgery.

Methods: Inclusion criteria: 1) Undergoing to major surgery; 2) high-risk for surgical complications defined by age≥ 70 and/or American Society of Anesthesiologists risk scale 3-4. The program included 6 interventions: 1) Cardiorespiratory training; 2) Promotion of physical activity; 3) Volumetric inspirometer teaching; 4) Cognitive behavioural therapy; 5) Nutritional optimization; 6) Mindfulness. Program completion was defined as attending ≥80% of appointments.

Results: From 200 patients, 120 (60%) completed the program. Among completers, 62 did not suffer from postoperative complications (52%). Undergoing oncologic surgery (24.5[3.9-153.8];p=0.001), suffering from endocrine and metabolic diseases (3.8[1.2-12.3];p=0.025) and willingness to participate in mindfulness sessions (3.1[1.03-9.15];p=0.044) were associated with program completion, while being older (0.93[0.88-0.97];p=0.002) was related to lower probability of completion. Among completers, higher baseline fitness (Duke Activity Status Index) (0.95[0.91-0.999];p=0.019) and higher risk of malnutrition (Malnutrition Universal Screening Tool) (1.8[1.1-3.1];p=0.023) were related to postoperative morbidity.

Conclusions: The current study identifies actionable factors useful to personalize these programs which may facilitate its effectiveness.

  • Physical activity
  • Physiotherapy care
  • Motivational interviewing

Footnotes

Cite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 2936.

This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.

This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).

  • Copyright ©the authors 2020
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Predictive modelling for optimization of preoperative care in multimorbid patients undergoing major surgery
Anael Barberan-Garcia, Mar Montane-Muntane, Alicia Hervas, Pilar Hurtado, Betina Campero, Bárbara Romano-Andrioni, Silvia Teres-Belles, Elena Gimeno-Santos, Josep Roca, Graciela Martinez-Palli
European Respiratory Journal Sep 2020, 56 (suppl 64) 2936; DOI: 10.1183/13993003.congress-2020.2936

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Predictive modelling for optimization of preoperative care in multimorbid patients undergoing major surgery
Anael Barberan-Garcia, Mar Montane-Muntane, Alicia Hervas, Pilar Hurtado, Betina Campero, Bárbara Romano-Andrioni, Silvia Teres-Belles, Elena Gimeno-Santos, Josep Roca, Graciela Martinez-Palli
European Respiratory Journal Sep 2020, 56 (suppl 64) 2936; DOI: 10.1183/13993003.congress-2020.2936
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