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      Preoperative Supervised Exercise Improves Outcomes After Elective Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial.

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          Abstract

          The aim of the study was to assess the impact of a preoperative medically supervised exercise program on outcomes after elective abdominal aortic aneurysm (AAA) repair.

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          Barriers and motivations to exercise in older adults.

          Although exercise is an established component in the management of many chronic diseases associated with aging, activity levels tend to progressively decline with increasing age. Given the growing proportion of older adults, these suboptimal levels of physical activity represent an increasing public health problem. The predicators of adherence elucidated in younger adults are unreliable in elderly populations. Age-specific barriers and motivators unique to this cohort are relevant and must be acknowledged. The identification of reliable predictors of exercise adherence will allow healthcare providers to effectively intervene and change patterns of physical activity in sedentary elderly. In particular, because older patients respect their physician's advice and have regular contact with their family doctor, physicians can play a key and pivotal role in the initiation and maintenance of exercise behavior among the older population.
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            The effects of preoperative exercise therapy on postoperative outcome: a systematic review.

            To summarize the current evidence on the effects of preoperative exercise therapy in patients awaiting invasive surgery on postoperative complication rate and length of hospital stay. A primary search of relevant key terms was conducted in the electronic databases of PubMed, EMBASE, PEDro and CINAHL. Studies were included if they were controlled trials evaluating the effects of preoperative exercise therapy on postoperative complication rate and length of hospital stay. The methodological quality of included studies was independently assessed by two reviewers using the PEDro scale. Statistical pooling was performed when studies were comparable in terms of patient population and outcome measures. Results were separately described if pooling was not possible. Twelve studies of patients undergoing joint replacement, cardiac or abdominal surgery were included. The PEDro scores ranged from 4 to 8 points. Preoperative exercise therapy consisting of inspiratory muscle training or exercise training prior to cardiac or abdominal surgery led to a shorter hospital stay and reduced postoperative complication rates. By contrast, length of hospital stay and complication rates of patients after joint replacement surgery were not significantly affected by preoperative exercise therapy consisting of strength and/or mobility training. Preoperative exercise therapy can be effective for reducing postoperative complication rates and length of hospital stay after cardiac or abdominal surgery. More research on the utility of preoperative exercise therapy and its long-term effects is needed as well as insight in the benefits of using risk models.
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              Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population.

              Randomized trials have shown reductions in perioperative mortality and morbidity with endovascular repair of abdominal aortic aneurysm, as compared with open surgical repair. Longer-term survival rates, however, were similar for the two procedures. There are currently no long-term, population-based data from the comparison of these strategies. We studied perioperative rates of death and complications, long-term survival, rupture, and reinterventions after open as compared with endovascular repair of abdominal aortic aneurysm in propensity-score-matched cohorts of Medicare beneficiaries undergoing repair during the 2001-2004 period, with follow-up until 2005. There were 22,830 matched patients undergoing open repair of abdominal aortic aneurysm in each cohort. The average age of the patients was 76 years, and approximately 20% were women. Perioperative mortality was lower after endovascular repair than after open repair (1.2% vs. 4.8%, P<0.001), and the reduction in mortality increased with age (2.1% difference for those 67 to 69 years old vs. 8.5% for those 85 years or older, P<0.001). Late survival was similar in the two cohorts, although the survival curves did not converge until after 3 years. By 4 years, rupture was more likely in the endovascular-repair cohort than in the open-repair cohort (1.8% vs. 0.5%, P<0.001), as was reintervention related to abdominal aortic aneurysm (9.0% vs. 1.7%, P<0.001), although most reinterventions were minor. In contrast, by 4 years, surgery for laparotomy-related complications was more likely among patients who had undergone open repair (9.7%, vs. 4.1% among those who had undergone endovascular repair; P<0.001), as was hospitalization without surgery for bowel obstruction or abdominal-wall hernia (14.2% vs. 8.1%, P<0.001). As compared with open repair, endovascular repair of abdominal aortic aneurysm is associated with lower short-term rates of death and complications. The survival advantage is more durable among older patients. Late reinterventions related to abdominal aortic aneurysm are more common after endovascular repair but are balanced by an increase in laparotomy-related reinterventions and hospitalizations after open surgery. Copyright 2008 Massachusetts Medical Society.
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                Author and article information

                Journal
                Ann. Surg.
                Annals of surgery
                Ovid Technologies (Wolters Kluwer Health)
                1528-1140
                0003-4932
                Jul 2016
                : 264
                : 1
                Affiliations
                [1 ] *Clinical Research Fellows: Academic Vascular Surgical Unit, University of Hull & Hull York Medical School, Hull Royal Infirmary, Anlaby Road, Hull, UK†Professor of Vascular Surgery/ Honorary Consultant Vascular Surgeon: Academic Vascular Surgical Unit, University of Hull & Hull York Medical School, Hull Royal Infirmary, Anlaby Road, Hull, UK‡Professor of Surgery/ Honorary Consultant Vascular Surgeon, Academic Vascular Surgical Unit, University of Hull & Hull York Medical School, Hull Royal Infirmary, Anlaby Road, Hull, UK.
                Article
                10.1097/SLA.0000000000001609
                26756766
                931e5bc9-f572-4123-9414-3e81e923e50c
                History

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