PRÉ-HABILITAÇÃO E PROGNÓSTICO PÓS-OPERATÓRIO EM DOENTES ONCOLÓGICOS DE ALTO RISCO: UMA REVISÃO SISTEMÁTICA E META-ANÁLISE

  • Fábio Teixeira-Oliveira Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Gleison Silva Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Fátima Santos Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal http://orcid.org/0000-0003-3796-2054
  • Pedro C. Martins Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal http://orcid.org/0000-0002-1828-078X
  • Daniel Moreira-Gonçalves Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal; Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal http://orcid.org/0000-0002-7404-7405

Resumo




Introdução: A pré-habilitação visa otimizar os doentes antes do tratamento cirúrgico, com o objetivo de melhorar a sua recuperação pós-cirúrgica. Embora a eficácia desta intervenção para melhorar os principais desfechos clínicos pós-operatórios tenha sido reconhecida para a população cirúrgica de baixo risco, ainda não está claro até que ponto estes benefícios serão extensíveis também para doentes considerados de alto risco. Esta meta-análise avaliou o impacto da pré-habilitação em desfechos pós-operatórios de doentes oncológicos cirúrgicos de alto risco.


Metodologia: Procuramos estudos experimentais (randomizados e não randomizados) e observacionais que avaliaram o impacto da pré-habilitação na frequência e / ou gravidade (major e minor) das complicações pós-cirúrgicas (desfecho primário), tipo de complicações, capacidade funcional, readmissões hospitalares, tempo de hospitalização e mortalidade pós-cirúrgica até 30 dias (desfechos secundários). Doentes de alto risco para eventos cirúrgicos adversos foram definidos como frágeis e / ou com idade ≥70 anos e / ou com score ASA> III.


Resultados: foram encontrados 136 artigos, dos quais apenas 6 foram elegíveis para avaliação qualitativa e quantitativa (3 estudos randomizados e 3 estudos observacionais). A análise global incluiu um total de 674 participantes, com idade média de 78 anos, a maioria do sexo masculino. A pré-habilitação reduziu o risco de complicações major (diferença do risco –0,09, IC 95%: –0,15, – 0,03, p = 0,005; i2 = 27%, p = 0,24) e de complicações cirúrgicas (RR 0,62, IC 95% 0,43 a 0,89, p = 0,01; I2 = 33%, p = 0,22) em comparação com doentes que receberam o tratamento habitual. Além disso, a pré-habilitação reduziu o tempo de hospitalização (diferença média de – 2,7, IC 95%: –5,37 a –0,17, p = 0,04) e melhorou a recuperação funcional avaliada pela distância percorrida no teste de marcha de 6 minutos (diferença média de 29,06 metros, IC de 95% 26,55 a 31,57, I2 = 42%, p <0,001). Não foram observadas diferenças para as complicações gerais, complicações médicas, mortalidade pós-operatória até 30 dias ou na readmissão hospitalar.


Conclusão: O nosso trabalho sugere que a pré-habilitação é eficaz na melhoria do prognóstico pós-operatório de doentes oncológicos considerados de “alto risco” para complicações cirúrgicas. Ficou evidente a necessidade de desenvolver ensaios clínicos randomizados especialmente focados em doentes cirúrgicos de alto risco, usando medidas de desfecho bem estabelecidas e clinicamente relevantes, e com cálculo de tamanho amostral adequado.




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Publicado
2022-02-03
Como Citar
TEIXEIRA-OLIVEIRA, Fábio et al. PRÉ-HABILITAÇÃO E PROGNÓSTICO PÓS-OPERATÓRIO EM DOENTES ONCOLÓGICOS DE ALTO RISCO: UMA REVISÃO SISTEMÁTICA E META-ANÁLISE. Revista Portuguesa de Cirurgia, [S.l.], n. 51, p. 99-114, feb. 2022. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/936>. Acesso em: 30 mar. 2023. doi: https://doi.org/10.34635/rpc.936.
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