Review Open Access
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2021; 13(8): 734-755
Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.734
Paradigm shift in gastrointestinal surgery − combating sarcopenia with prehabilitation: Multimodal review of clinical and scientific data
Frederick H Koh, Fung-Joon Foo, Winson J Tan, Sharmini S Sivarajah, Leonard Ming Li Ho, Min-Hoe Chew, Division of Surgery, Sengkang General Hospital, Singapore 544886, Singapore
Jason MW Chua, Joselyn LJ Tan, Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore 138673, Singapore
Bin-Tean Teh, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore 169610, Singapore
ORCID number: Frederick H Koh (0000-0002-3717-4480); Jason MW Chua (0000-0003-1129-1037); Joselyn LJ Tan (0000-0001-8340-9933); Fung-Joon Foo (0000-0002-7347-4894); Winson J Tan (0000-0003-1628-3650); Sharmini S Sivarajah (0000-0001-9279-4984); Leonard Ming Li Ho (0000-0002-4608-0830); Bin-Tean Teh (0000-0003-1514-1124); Min-Hoe Chew (0000-0003-4701-0460).
Author contributions: Koh FH and Chua JMW contributed equally to this work; Koh FH, Chua JMW, Teh BT and Chew MH conceptualized the study; Koh FH, Chua JMW performed the review and wrote the manuscript; Tan JLJ, Foo FJ, Tan WJ, Sivarajah SS and Ho LML contributed key inputs to and edited the manuscript; All authors have read and approve the final manuscript.
Conflict-of-interest statement: All authors have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Frederick H Koh, FRCS (Ed), MBBS, Assistant Professor, Surgeon, Division of Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore. frederickkohhx@gmail.com
Received: February 22, 2021
Peer-review started: February 22, 2021
First decision: May 4, 2021
Revised: May 8, 2021
Accepted: July 12, 2021
Article in press: July 12, 2021
Published online: August 27, 2021

Abstract

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes. These included an increased risk of total complications, major complications, re-admissions, infections, severe infections, 30 d mortality, longer hospital stay and increased hospitalization expenditures. A program to enhance recovery after surgery was meant to address these complications; however, compliance to the program since its introduction has been less than ideal. Over the last decade, the concept of prehabilitation, or “pre-surgery rehabilitation”, has been discussed. The presurgical period represents a window of opportunity to boost and optimize the health of an individual, providing a compensatory “buffer” for the imminent reduction in physiological reserve post-surgery. Initial results have been promising. We review the literature to critically review the utility of prehabilitation, not just in the clinical realm, but also in the scientific realm, with a resource management point-of-view.

Key Words: Sarcopenia, Prehabilitation, Surgery, Frailty, Value, Gastrointestinal surgery

Core Tip: The geriatric surgical population is rapidly growing and hence, clinicians have to take into account additional risk factors such as frailty. In particular, it is evident that sarcopenia is an independent predictive factor of postoperative outcomes. Prehabilitation represents a paradigm shift in geriatric surgical care, with the goal of enhancing functional capacity to withstand a forthcoming stressor. Emerging data has inspired healthcare professionals to not only adopt a multimodal approach, but also to pivot towards personalized programs.



INTRODUCTION

A patient undergoing surgical procedure is subjected to a major stressor, and depending on the magnitude of the surgery, induction of the surgical stress response culminates in the derangements of metabolic processes and disruption of homeostasis[1]. Notwithstanding any surgical complications, major surgeries have been shown to reduce physiological and functional capacity of up to 40%. In addition, the subsequent inactivity and bed rest will induce rapid muscle atrophy, further resulting in muscle deterioration[2]. Hence, a fitter individual that can overcome the metabolic deconditioning will tend to recover faster and regain physical fitness back to baseline level. On the contrary, geriatric patients tend to have lower reserve, a mismatch to the physiological demand placed on the body, causing a delayed postoperative recovery. It is evident that increasing age is an important risk factor for postoperative adverse outcomes, such as prolonged length of stay (LOS), increased chance of complications, morbidity, and mortality[3-6]. The increased prevalence of postoperative comorbidities among elderly patients necessitates the implementation of preoperative regimes to mitigate such a phenomenon.

Frailty is a multifactorial phenomenon associated with aging that is characterized by an accelerated decline in physiological reserve and function across multiple organ systems of the body. A major component of frailty is sarcopenia, defined as the progressive loss of muscle mass and strength. It is also characterized by negative alterations in muscle architecture and poor muscle quality, concomitant with diminished regenerative capacity[7]. Not only does skeletal muscle coordinates contraction to enable locomotion, but also, from a metabolic angle, it regulates energy production, glucose uptake, and protein metabolism throughout the body[8,9]. Therefore, it is not surprising that skeletal muscle is one of the primary tissues mobilized to counteract the deficit in physiological reserve caused by the surgical stress response. It cannot be overemphasized that a patient must be physically fit to abate the physiological stressors to increase the probability of better surgical outcomes.

This is a review on the utility of prehabilitation to combat the effects on sarcopenia on surgical patients. We focused on the effects of sarcopenia on surgical outcomes, the rationale behind the increasing adoption of prehabilitation, and review the outcomes and cost effectiveness of such programs.

SARCOPENIA CORRELATES WITH ADVERSE SURGICAL OUTCOMES

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients and is an independent predictor of postoperative complications and outcomes. As attested by the numerous studies and reviews conducted, sarcopenia and its defining characteristics, such as low skeletal muscle mass, strength, and functional capacity, are associated with adverse outcomes. For example, a study demonstrated that patients with sarcopenia undergoing surgery for colorectal cancer had a higher incidence of postoperative complications, particularly infectious complications[10]. The study also highlighted that integrating functional components of sarcopenia, such as muscle strength or physical performance, more accurately predicted postoperative complications. This was corroborated by another study in which sarcopenia was associated with more postoperative complications in sarcopenic patients with rectal cancer[11]. In addition, sarcopenia was shown to be a significant independent predictor of 1-year mortality in patients who had elective curative colorectal resection for cancer[12]. The sarcopenic group was significantly correlated with worse survival at 1 year, with an overall 1-year mortality of 15.6% compared to the non-sarcopenic group at 5.3%. Additionally, several meta-analyses conducted on patients undergoing gastrointestinal surgeries found similar results. In brief, a meta-analysis that included 11 cohort studies with 2419 participants demonstrated that sarcopenia was a high-risk factor for negative digestive carcinoma surgery outcomes[13]. These included an increased risk of total complications, major complications, re-admissions, infections, severe infections, 30-d mortality, longer hospital stays, and increased hospitalization expenditures. Similarly, another meta-analysis that included 11 studies with 4265 gastrointestinal surgery patients highlighted that sarcopenia was associated with an increase in late postoperative complications and the number of postoperative hospital readmissions[14]. Furthermore, a meta-analysis that interrogated seven observational cohort studies totaling 1440 patients, revealed a significant link between low muscle mass and mortality in patients undergoing abdominal aortic aneurysm repair[15]. Interestingly, one study demonstrated that detection of both preoperative sarcopenia and accelerated muscle loss after surgery in pancreatic cancer patients were associated with negative overall survival[16].

There are several studies documenting similar findings in patients undergoing cardiac surgeries. In a large single-center retrospective study involving 1119 patients that underwent heart valve surgery via median sternotomy, the sarcopenic group had significantly decreased long-term survival and increased major adverse cardiovascular events[17]. Similarly, out of 266 patients who underwent elective total arch replacement, 81 sarcopenic patients had a significantly worse 5-year survival, demonstrating that sarcopenia can be an additional risk factor to estimate the outcomes of thoracic aortic surgery[18]. In addition, lower psoas muscle area was associated with an increase in long-term mortality and in-hospital mortality or major morbidity in patients that underwent orthotopic heart transplantation[19]. Moving on to the respiratory system, a retrospective study consisting of 328 non-small-cell lung carcinoma (NSCLC) patients who underwent curative resection determined that sarcopenia was an independent unfavorable prognostic factor[20]. The sarcopenic group had a 5-year survival rate of 61% relative to 91% in non-sarcopenic group. Likewise, a meta-analysis involving 6 cohort studies consisting of 1213 patients with surgically treated NSCLC yielded similar findings. Sarcopenic patients had a significantly worse prognosis than those without, which was more prominent in patients with early-stage NSCLC[21]. Overall, there is mounting evidence that loss of muscle mass and strength, concomitant with an insidious functional decline, are strongly associated with unfavorable surgical outcomes.

Even though the principal findings of these studies have garnered traction among clinicians in using sarcopenia as an objective tool to identify high-risk patients and a predictor of outcomes, several recurring flaws were presented. These included the retrospective[11,15,16,18-21] nature of the studies conducted in single-center[12,17,20] settings in which sample sizes were limited[10,11,17,19-21], decreasing statistical power. The paucity of large prospective studies might be a potential source for selection bias, confounding factors and absent data. Furthermore, relationships between sarcopenia and other variables could not be analyzed due to inadequate cases. Next, as there is currently no universally accepted definition of sarcopenia, a wide spectrum of methodologies and cut-off values were utilized in these studies[10,12,14,15,21]. Just for muscle mass assessment alone, measurement techniques range from dual-energy X-ray absorptiometry, computed tomography, and bioelectrical impedance analysis, which may complicate the results. In addition, most studies depended solely on muscle mass evaluated by tomograph, as it is routinely examined by clinician, whilst neglecting functional criteria such as muscle strength[11,14,17], which is known to be a better predictive factor of adverse results. Another drawback was the variation in regions of muscle quantified such as the total skeletal muscle area in the third lumbar vertebra or the total psoas muscle area. Moreover, each study utilized slightly different threshold for defining low muscle mass or segregated their patient cohorts into tertiles to arbitrarily determine sarcopenic groups. Lastly, the findings were derived mostly from single-center studies that focused on a particular ethic group, indicating that the results may not be representative of the general population[14,16,17]. All these variables could cause significant heterogeneities and affect the validity of the results.

Nevertheless, the data provides a solid foundation to carry out multi-institutional prospective studies in the near future to circumvent the abovementioned limitations and reaffirm the results. Once these findings are validated and provides irrefutable evidence demonstrating a causal relationship between sarcopenia and adverse surgical outcomes, standardized method of assessment for sarcopenia and cut-off values can then be established. The results also reiterated the importance of conducting a preoperative evaluation for the diagnosis of sarcopenia as part of risk assessment during the planning for surgical procedures. Being able to stratify patients according to the severity of their condition as diagnosed according to the EWGSOP or AWGS consensuses will allow the formulation of personalized intervention to diminish its impact on the patient’s health. Nevertheless, sarcopenia is a remediable risk factor that can be mitigated prior to surgery and may have profound effects in postoperative recovery.

ENHANCED RECOVERY AFTER SURGERY – WHY DO WE NEED SOMETHING BETTER?

It has been two decades since the conceptualization of enhanced recovery after surgery (ERAS) protocol in 2001 by Fearon and Ljungqvist[22]. During these two decades, the principles of ERAS have been refined and assimilated into numerous types of surgeries[23-26]. The aim of the ERAS protocol has been to “develop perioperative care and to improve recovery through … evidence-based practice”. However, the full adoption of the ERAS protocol has been difficult. In 2007, the ERAS Society recognized that simply having a protocol was insufficient to change widespread medical treatment, and more accurately, surgical practice[27]. Despite the efforts by various affiliated societies like the European Society for Clinical Nutrition and Metabolism and the International Association for Surgical Metabolism and Nutrition, the ERAS protocol is still yet to be fully adopted[28-30]. Recent evidence has shown that compliance to the protocol ranges only about 60%-65% at best, with a study from Singapore indicating that only 26.7% of surgeries adhered to > 70% compliance to ERAS principles[31]. When split into the pre-, intra- and post-operative components, one study revealed that postoperative protocol compliance was only 30%[30].

Despite having a consensus protocol supported by evidence, the lack of compliance by practitioners is most definitely multifactorial. Firstly, the ERAS principles require a mindset shift of not just a single specialty, but multiple. These include patients, nursing staff, surgeons, intensivists, anesthesiologists, and even the higher hospital administration. Everyone needs to be involved in the implementation of these protocols, and convincing such a diverse field of professionals to modify their practice is a tall order. Secondly, compliance has shown to be critical for patients to reap the benefits of the entire protocol[32,33]. Gianotti et al[32] highlighted in a multicenter prospective study that a > 70% compliance to ERAS had a 0.413 odds of having a lower overall surgical morbidity. There are more than 20 principles of ERAS distributed between pre-, intra- and post-operative components, rendering it logistically and technically challenging to fully comply. Thus, having a simpler system might actually allow greater compliance and thus, greater benefit to the patients. Having an overly complex system without accessory support (clinical coordinators, clinical champions, etc.) will inevitably result in poorer compliance. Thirdly, a majority of rehabilitative programs begin after surgery and in order for patients to reap the most benefits, a multitude of studies have advocated at least 1-2 mo of rehabilitation[34-36]. However, upon discharge, patients’ compliance to the exercise and nutrition regime is often at best 70%[28-31]. Having the mentality that surgery is the definitive step in the removal of their pathology is a misconception that needs to be weeded out. A plausible reason for higher compliance to a prehabilitative program can stem from the fact that patients want to optimize their body in the lead up to their surgery, thus remaining cooperative to the nutritional and exercise interventions[37,38]. Most importantly, a lack of flexibility to tailor intra- and post-operative treatments will greatly impair the surgeons’ compliance to the protocol[39].

Surgery is often mistaken as just a technical procedure; a completion of steps one to twenty for the “treatment” to be completed. In truth, just like any field in medicine, surgery is an art. Not every colectomy is the same to the one before. There are intricacies of the procedure, the aggressiveness of the tumor, the differences in technical challenge, and more crucially, the surgeons’ concern for every case may differ. As such, requiring a surgeon to conform to the same intra- or post-operative management of every surgery is inherently impossible since every procedure is distinct. By adhering to the ERAS protocol, surgeons may feel that their “control” over the patient’s progress is, in a way, removed from their hands. This can be difficult to accept especially when they have to shoulder the responsibility or any subsequent morbidity and mortality. It is in the authors’ opinion that implementing a personalized prehabilitation program will alleviate the surgeon’s emotional investment and enhance professional capacity during the procedure. As such, the compliance to such a program would likely surpass that of ERAS.

This concept has its detractors, of course, with one single-center randomized trial comparing a prehabilitation and rehabilitation program for frail patients undergoing minimally invasive colorectal resections[40]. Of the 110 randomized, there was no difference in 30-d surgical morbidity, length of hospitalization, readmission within 30 d from operation, and other patient reported outcomes measures. However, one may argue, looking at the numbers, that it might be insufficiently powered when their primary outcome measure was complication rates, with minimally invasive colectomies complication rate in tertiary institutions being < 10%.

WHAT IS PREHABILITATION? – ORIGIN AND COMPONENTS

The negative physiological effects of a major surgery include muscle proteolysis due to postoperative hypercatabolism[41], systemic inflammation[42], and pulmonary complications[43]. All these may culminate in muscle atrophy, loss of muscle strength, reduction in cardiorespiratory fitness and a decrease in oxidative capacity. For vulnerable surgical patients who are frail, elderly or sarcopenic, the inability to withstand the insult of a surgery is greatly amplified due to depleted physiological reserve, further diminishing the odds of recovery. The presurgical period represents a window of opportunity to boost and optimize the health of an individual, providing a compensatory “buffer” for the imminent reduction in physiological reserve post-surgery. Prehabilitation is the process of augmenting a patient’s functional capacity through various preoperative regimes to withstand a forthcoming stressor, with the goal of improving postoperative outcomes. As a multitude of factors such as the physical, psychological, and nutritional status of a patient significantly impact the success of a surgery, prehabilitation programs are trending towards a multimodal approach. These encompass physical exercises, nutritional optimization and psychological support. The synergistic effects of targeting key elements of a patient’s overall health condition can maximize surgical treatment outcomes.

NUTRITIONAL SUPPLEMENTATION

Nutritional status has been shown to be an independent predictor of postoperative complications in patients[44,45]. For example, preoperative serum albumin concentration, which is a surrogate marker for nutritional status, has been associated with morbidity, mortality, and LOS[46-48]. In one study, following anterior cervical discectomy and fusion, hypoalbuminemic patients had a significantly longer hospital stay relative to patients with normal serum albumin of 5.00 d and 1.88 d, respectively[44]. Hence, nutritional conditioning aims to identify and rectify areas of deficit to increase functional reserve preoperatively, minimizing the risk of adverse outcomes. It is important to recognize that nutrition supplementation does not adhere to the “one-size-fit-all” approach. For example, a systematic review highlighted that carbohydrate loading (CL) during the preoperative phase significantly reduced insulin resistance in patients[49]. On the contrary, preoperative CL increased postoperative tumor proliferation and exacerbated clinical outcomes in estrogen receptor positive T2 patients[50]. Depending on the disease, surgical procedures and nutrition deficits, concomitant with an appropriate nutrition screening, a targeted program can be formulated to optimize an individual’s reserve. Nevertheless, the overall goal is to increase nutrient stores and metabolic reserve while augmenting physical strength to improve postoperative recovery.

There is no standardized regime specifically for patients with sarcopenia, with the type of nutrition, amount and duration varying between studies. A majority of prehabilitation programs focus mainly on protein supplementation for the purpose of anabolism. The pathogenesis of sarcopenia is multifactorial and implementing a nutritional intervention has to address a plethora of signaling pathways. Firstly, there is a dysregulation of anabolic and catabolic networks[51], favoring disproportionate muscle protein breakdown rather than synthesis. In some studies, branched-chain amino acids, which constitute three of the nine essential amino proteins, were supplemented preoperatively. These amino acids, in particular leucine, play a vital role in the regulation of anabolic signal transduction[52]. Leucine activates the mammalian target of rapamycin (mTOR) signaling and eukaryotic initiation factor 4G that promote translation and protein synthesis[53]. In addition, branched chain amino acids has been demonstrated to attenuate protein degradation rate[54,55]. Another common form of protein supplementation is the provision of whey protein, which is extracted from the whey that remains after milk is curdled and strained, containing all nine essential amino acids. Whey protein consists of a high proportion of branched chain amino acid, augmenting anabolic processes[52]. In addition, whey has high amount of cysteine, the rate-limiting amino acid for the synthesis of intracellular glutathione, the dietary antioxidant. This additional redox defense may be beneficial as oxidative stress has been shown to increase in sarcopenia[56] and induce during surgical stress response[57,58]. Next, sarcopenic patients manifest a heightened inflammatory state[59], associated with high levels of proinflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and macrophage migration inhibitory factor[60-62]. The added benefit of whey protein is that it contains α-lactalbumin and lactoferrin, which have been demonstrated to inhibit the production of proinflammatory cytokines such as TNF-α and IL-6 in rat and human myogenic cells[63,64].

As muscle is the principal site of glucose disposal and plays a paramount role in maintaining blood glucose homeostasis, it is deemed to be the primary determinant of whole-body insulin resistance. Numerous studies have shown that sarcopenia and skeletal muscle mass are associated with impaired fasting glucose, diabetes, and insulin resistance[65-68] The condition is exacerbated during surgery in which insulin resistance is a central metabolic change during surgical stress. Insulin resistance is known be associated with an increased risk of complications, morbidity and an independent factor influencing LOS postoperatively[69,70]. One noteworthy strategy employed in several studies is perioperative CL to mitigate the impact of surgical stress. CL has been demonstrated to significantly diminish insulin resistance and, in some cases, halved the initial value[49,71]. In brief, CL suppresses the expression of muscle pyruvate dehydrogenase 4, alleviating the inhibition of the pyruvate dehydrogenase complex, allowing pyruvate to enter the Kreb’s cycle. In addition, CL augments PI3K activity and expression of protein kinase B, which are important mediators of the insulin signaling pathway, ameliorating peripheral insulin resistance[72]. Secondly, CL has shown to attenuate depletion of muscle mass after elective abdominal surgery[73]. However, the available data pertaining to CL and postoperative outcomes in sarcopenic patients is limited, and more studies are required to investigate this association and optimize this aspect of enteral nutritional support.

Other nutrients may play a vital role in complementing or augmenting the protein anabolic response. For example, vitamin D is a steroid hormone that modulates muscle anabolic state and muscle energy metabolism[74]. In addition, it plays an important role in regulating the body’s levels of calcium and phosphorus, which are responsible for controlling muscle contraction, relaxation, and function[75]. Vitamin D is commonly reduced in elderly subjects[76,77] and its deficiency is associated with disruption of mitochondrial function, oxidative stress and muscle atrophy[74,78]. Hence, it is not surprising that in elderly subjects, supplementing vitamin D was shown to enhance muscle mass and chair-stand test time, a surrogate of muscle power[79]. This can be partly attributed to the improvement of mitochondrial oxidative function in skeletal muscle. Furthermore, a meta-analysis of 13 randomized controlled trials (RCTs) in elderly subjects above 60 years highlighted that vitamin D supplementation elicited beneficial effects on strength and balance[80]. Next, omega-3 fatty acids, which has shown to augment the protein anabolic response and exert anti-inflammatory properties[81], can potentially be a useful dietary supplement to improve muscle health. In one study, omega-3 fatty acid augmented muscle protein synthesis (MPS) in healthy older adult, most likely by an increased activation of mTOR[82]. Additionally, sarcopenic patients have been shown to manifest reduced level of circulating vitamin B12, which have a prominent role in modulating muscle strength and function[83]. Supplementing vitamin B12 may have a direct impact on muscle performance and physical function in high-risk patients. Other supplements, such as epicatechin[84] and urolithin A[85], found in pomegranate, are also interesting options that have proven to improve muscle growth factors and modulate skeletal muscle mitochondrial gene expression, respectively.

PHYSICAL ACTIVITY MODIFICATION

The main objective of exercise prehabilitation is to improve physiological reserve and fitness, which are modifiable risk factors that can reduce surgical complications. Two fundamental components of exercise prehabilitation are aerobic/endurance and resistance/strength exercises. In the context of high-risk population such as frail or sarcopenic patients, they may benefit more from such exercise prehabilitation. Firstly, the concept of aerobic training is to improve an individual cardiovascular fitness though a prolong period of low contractility that depends mainly on slow-twitch muscle fibers. This extended, yet low intensity, form of physical activity has been shown to induce mitochondrial biogenesis, ATP production, muscle mass, and strength in older subjects[86-89]. Mechanistically, aerobic exercise activates the energy sensing network that involves AMPK, p38 MAPK, and SIRT1 proteins[90-92]. These proteins initiate the mitochondrial biogenesis program through the activation of the transcriptional co-activator PGC-1α. This in turn drives mitochondrial gene transcription through a subset of transcription factors. Next, aerobic exercise has been demonstrated to reduce the expression of catabolic genes[93,94] and increase MPS[95] in older subjects. Furthermore, exercise may increase the expression of autophagy-related proteins in skeletal muscle[96], a process vital in basal myofiber homeostasis and muscle integrity.

Alternatively, resistance exercise aims to induce muscle hypertrophy and strength via a short period of high contractility against an external load. It is dependent on fast-twitch muscle fibers that are able to generate a bigger force but fatigue quickly. Resistance training (RT) is critical in preventing muscle atrophy because it stimulates protein synthesis and hypertrophy, enhancing muscle strength. In the context of sarcopenic patients, the favorable effects of RT include increase in muscle mass, strength, quality and functional performance[97-99]. Mechanistically, RT activates the mTOR pathway, a central mediator of protein synthesis and skeletal muscle size[100]. Concomitantly, RT upregulates extracellular signal-regulated kinase 1/2, modulating translation initiation and protein synthesis[101]. Both these mechanisms underlie the resistance exercise-induced anabolic responses. In addition, after RT exercises, testosterone levels have been shown to increase in the sarcopenic group[97], the main physiological anabolic hormone that maintains muscle mass and function. RT has a dual effect in which it suppresses catabolic networks that drive muscle degradation and atrophy. For example, it is known to reduce myostatin concentration[97], a member of the transforming growth factor β family. Myostatin is a potent negative regulator of skeletal muscle regeneration and growth. The myokine also inhibits myogenic cell proliferation, myoblast fusion and the expression of several muscle-specific genes[102]. Furthermore, RT has been demonstrated to attenuate the expression of FOXO3a and MuRF1[89,94], which are part of the ubiquitination cascade that results in the degradation of myofibrillar proteins.

In summary, both forms of physical exercise elicit different beneficial outcomes. Aerobic training has a greater influence on mitochondrial dynamics and cardiovascular fitness, while RT is more effective in increasing muscle mass and strength. As both muscle strength and cardiorespiratory fitness decline during the postoperative period, it is conceivable that the combination of these exercises can offer the advantages of both. Numerous studies have adopted a well-rounded exercise program to reap the synergistic effect in improving functional reserve and fitness in older adults[103,104]. Beyond the physical enhancement, exercise is recognized to decrease pro-inflammatory cytokines and boost plasma levels of anti-inflammatory ones, creating an anti-inflammatory environment[105]. In addition, the anti-oxidative effects of exercise via decreased ROS production, a greater mitochondrial capacity to scavenge free radicals, and enhanced antioxidant defenses[106], further reiterate the need to incorporate exercise programs in combating sarcopenia.

Ideally, the exercise intervention ought to be targeted and individualized to optimize surgical outcomes. Factors, such as baseline functional capacity, nutritional status, frailty status and patient’s compliance have to be taken into consideration. Due to disease heterogeneity and diverse patient profiles, it is not surprising that an optimal prehabilitation exercise regime has not been defined, often differing in duration, intensity and frequency. Nevertheless, the various repertoire of exercise programs implemented have a collective goal at improving functional capacity. In general, a baseline assessment of functional capacity is first performed to provide an initial benchmark for reference. Two frequently used tests are the cardiopulmonary exercise test and the 6-min walk test. From the initial assessment, a multidisciplinary group can formulate an intervention that best suit the patient that optimizes surgical outcomes. Throughout the prehabilitation period, the patient must be reviewed regularly in order to verify if the stimulus is adequate or excessive. Parameters, such body composition measurement, muscle strength, heart rate, and fatigue level, have to be meticulously recorded.

PSYCHOLOGICAL PREPARATION AND MOTIVATION – THE BELITTLED YET CRUCIAL COG

It is evident that psychological distress is associated with negative surgical outcomes[107]. Anxiety and depression can lead to higher levels of pain[108] and non-compliance with prehabilitation programs, severely compromising its impact. In brief, negative emotions may heightened pain sensitivity and preoperative stress may induce glucocorticoid productions that delay wound healing[108,109]. This is especially detrimental for high-risk patients who have low functional reserve and may worsen health status or delay postsurgical recovery. In one retrospective cohort study, elderly patients that underwent surgery for lumbar spinal stenosis demonstrated that anxiety was identified as a preoperative factor that influenced patient satisfaction with surgery[110]. The authors highlighted the importance of evaluating the preoperative psychological state of elderly patients undergoing such surgery. There are studies that have also shown that cognition and psychological well-being were significantly associated with mortality in elderly patients undergoing surgery[111,112]. In addition, several psychosocial factors, such as anxiety, increased the likelihood of adverse outcomes in frail elderly patients, which included long LOS and rehospitalization[113]. Interestingly, psychosocial factors have indicated to be associated with reduced muscle mass, strength, and function in elderly subjects[114].

Patients can first be screened for anxiety and depression using the GAD-7 and PHQ-9 questionnaires. Psychological interventions can then be put in place for those detected at high-risk to alleviate the stress of surgery or for psychological support. These include referral to a psychologist, cognitive behavioral therapy, and relaxation and breathing techniques[115-117]. To realize the future of modern healthcare and increase efficiency of health systems, integration of technology in clinical treatment is paramount. This will allow facilitation of psychological interventions to markedly improve the health status and well-being in older patients. Technology-based interventions, such as virtual reality, robots, and smartphone applications, have the potential to support psychological treatment in high-risk patients[118]. Overall, despite the body of evidence demonstrating that cognitive and psychological status are vital components of health in high-risk patients, it is often neglected and not used in determining the risk of adverse postsurgical outcomes. The identification of these factors can assist in patient care planning and to detect patients who may not be able to withstand the stress of surgery.

ALL HANDS ON DECK – A MULTIMODAL APPROACH TO PREHABILITATION

In older or sarcopenic patients, anabolic resistance in muscle is observed, in which the muscle exhibits a blunted response to anabolic stimuli, such as intake of protein and resistance exercise[119,120]. Factors such as insulin resistance, chronic low-grade inflammation and physical inactivity have been shown to be contributors to this phenomenon[121,122]. Mechanistically, several signaling networks are involved in modulating the diminished rate of MPS despite the presence of an anabolic stimulus. In brief, a dysregulated AKT-mTOR signaling is likely to be implicated for the reduced response to anabolic stimuli[123]. An increased basal expression of inflammatory cytokines, like NFκB, TNF-α and IL-6, are known to suppress muscle anabolism by impairing protein synthesis via the mTOR pathway[124-126]. Therefore, it may be efficacious to induce both anabolic stimuli, ensuring that it is adequate for the coordinated increase in MPS. The synergistic effects of exercise and nutrients, in particular amino acids, provide the requisite anabolic environment and building blocks to support protein synthesis. It is well documented that nutrient intake during post-exercise period is needed to bring about a positive net protein balance. This is associated with increased phosphorylation of components of the mTOR signaling cascade beyond levels that are detected following exercise without nutrients[127,128].

In the elderly, several studies have attested to the additive effects of exercise and nutrition, with a greater rate of protein synthesis than feeding alone[129,130]. In addition, another systematic review demonstrated that a combination of exercise and amino acid-based nutrition was sufficient to induce a comparable MPS response between young and older individuals compared to either intervention alone[131]. As highlighted by the authors, the exercise volume and nutrient quantity must be above a certain threshold to stimulate equivalent MPS rates in young and older adults, below which age-related muscle anabolic resistance may become apparent. In the same vein, the functional benefits of implementing both interventions are observed in patients with sarcopenia as well. For example, RT and epicatechin supplementation demonstrated the greatest improvement on improving muscle growth factors and preventing the progression of sarcopenia in sarcopenic older patients[84]. Similarly, a meta-analysis carried out involving 429 sarcopenic elderly highlighted that nutritional supplement boosted the effects of exercise intervention such as an increase in muscle mass, strength and physical performance[132]. Another meta-analysis that included data from 22 RCTs and 680 subjects corroborated the previous findings in which protein supplementation augmented the adaptive response of the skeletal muscle to prolonged resistance-type exercise training in both younger and older population[133]. The additional gains in muscle mass and strength are especially important for older or sarcopenic patients to increase their functional capacity to withstand the stress of a surgery. In one study, elderly patients scheduled for colorectal cancer surgery underwent a prehabilitation program that involved physical and nutrition interventions with relaxation exercises to reduce anxiety[134]. Patients in the prehabilitation group significantly increased the amount of physical activities that they performed, which translated into improvements in functional walking capacity. Over the years, there is a radical change in prehabilitation programs, pivoting from unimodal to multimodal approach, due to the synergistic effects observed in a plethora of studies. It is incumbent on us to build upon these results and to evaluate its beneficial effect on surgical outcomes in high-risk patients.

PREHABILITATION FOR THOSE WHO WOULD TRULY BENEFIT - HIGH-RISK PATIENTS

The focus of this review is to evaluate the impact of prehabilitation programs on a subset of high-risk patients that are elderly, frail, or manifest characteristics of sarcopenia. This allows healthcare professionals to recalibrate their approach in managing this vulnerable population, optimizing a prehabilitation program that is tailor-made to individual patient based on the totality of data presented.

ELDERLY PATIENTS

It is evident that implementing prehabilitation programs have immense benefits in improving postsurgical outcomes for elderly patients. In one study, elderly patients undergoing elective abdominal cancer surgery took a preoperative comprehensive geriatric assessment for interprofessional preoperative evaluation and care coordination[135]. The preoperative assessment team focused on a holistic perioperative health optimization that encompassed cognitive, functional, and nutritional status. Patients in the intervention group manifested more desirable health outcomes in the postoperative period, with a reduction in the median LOS, lower readmission rates, fewer mean number of complications, and improvement in independence on discharge. However, there was a significantly higher incidence of delirium, a common complication in elderly patients undergoing major abdominal surgery in the intervention group. The authors postulated that the screening conducted by the program most probably attributed to the increased detection that was previously underdiagnosed in the control group. On the contrary, patients aged 70 years and older undergoing elective abdominal surgery for colorectal carcinoma or aortic aneurysm had significantly reduced incidence of delirium upon completion of the prehabilitation program[136]. Hence, embarking on a prehabilitation program can potentially be helpful in mitigating the risk of developing post-surgery delirium, warranting further investigations with higher quality study designs. To further reiterate its beneficial effects, another prehabilitation regime that comprised of endurance exercise training and nutritional intervention reduced the number of elderly patients with postoperative complications undergoing major abdominal surgery compared to control group[137]. In a similar vein, another study investigated the impact of a comprehensive multidisciplinary care program that consisted of both prehabilitation and rehabilitation components[138]. It was implemented for elderly patients that underwent elective surgery for stage I-III colorectal cancer that included exercise, nutrition and psychological interventions. Patients who followed the whole multimodality program or partook a portion of it exhibited a significant reduction in prolonged LOS and severe complications. However, the merger of both prehabilitation and rehabilitation components meant that the role of prehabilitation alone could not be assessed, and more studies are required to independently evaluate its effectiveness. However, several findings did demonstrate that even though prehabilitation did not negatively impact postoperative course in elderly subjects, it did not elicit any significant beneficial effect[139-141].

These results merit further investigation to evaluate the effectiveness of preoperative regimes in elderly patients. Higher quality clinical research studies must be conducted to address shortcomings such as small sample size, flawed research designs and a limited range of surgical specialty. There are several key factors that may be imperative in developing successful prehabilitation programs for geriatric patients. Firstly, a comprehensive geriatric assessment is vital to evaluate the health status of patients and to formulate the appropriate treatment plans. A qualified team of clinical professionals has to be designated to conduct, develop, implement and monitor the entire process. Next, stratifying patients who are at higher risk of developing adverse postoperative outcomes allows personalization of the interventions. The program can then be modified, such as modulating the frequency and intensity of an exercise, or devising a nutrition plan that optimizes the patients’ physiological reserve. It is also advisable to track the metabolic and functional changes of the patients at specific timepoints to monitor the effectiveness of the prehabilitation program.

FRAIL AND SARCOPENIC PATIENTS

Frailty and sarcopenia are common age-related conditions that are associated with adverse surgical outcomes. Therefore, these group of patients may gain more from undergoing prehabilitation programs that can substantially improve their physiological capacity. In one study, frail patients undergoing elective oncologic surgery of upper gastrointestinal tract were stratified based on their frailty status[142]. Those patients that underwent a multidisciplinary preoperative management plan that included oral nutritional support and aerobic exercises had a significant reduction in 30-d and 3-mo mortality rates, together with a decrease in overall and severe complication rates compared to control group. These likely translated to a shorter LOS observed but did not reach statistical significance. Due to the physical or socioeconomic status of a patient, it may not be feasible to conduct a prehabilitation program in the host institute. Hence, a home-based approach is a viable option, even though it may not be optimal for the patients to do or for investigators to collect data. For example, frail patients undergoing major colorectal resection partook a multimodal prehabilitation program either at home or in the day rehabilitation center[143]. The mean length of hospital stay was significantly shorter for patients that underwent the program compared to the control group, indicating the possibility of implementing a trans-institutional approach in the home setting. Nevertheless, only a minority of patients in the intervention group were frail (26.4%), and a subgroup analysis should be carried out to validate the findings. Another systematic review carried out supported the growing body of evidence, reiterating the importance of prehabilitation programs to gear towards a multimodal approach to maximize its effectiveness in improving health status prior to surgery[144]. This review interrogated the role of prehabilitation and surgical outcomes in frail surgical patients. In summary, the studies that implemented a multimodal program, which included preoperative exercises and nutrition interventions, led to a reduction in mortality and duration of hospital stay[143,144]. On the other hand, studies that implemented an exercise intervention alone did not demonstrate any significant difference in postoperative functional recovery[145-147]. Nevertheless, limitations of these studies included the use of various frailty indices, risk of bias and small sample sizes. These have to be addressed in large randomized controlled studies to determine the validity of the results.

On the contrary, there are findings that call in question the effectiveness of prehabilitation programs in eliciting favorable outcomes in high-risk patients. One study indicated no statistical significance in postoperative outcomes when implementing the same multimodal program preoperatively or postoperatively in frail patients undergoing predominantly minimally invasive colorectal cancer resection[40]. The authors listed reasons that could have accounted for the lack of effect of prehabilitation observed in the trial. Firstly, the simultaneous implementation of an established enhance recovery pathway might have masked the impact of an unoptimized prehabilitation program. In addition, the authors also hypothesized that the duration of the program, which lasted a maximum of 5 wk, might be inadequate to raise functional reserve to a threshold level that substantially mitigated negative surgical outcomes. The use of a rehabilitation control group rather than the usual care or a sham intervention made the study more clinically relevant. However, this might have limited the effects observed in patients that underwent the prehabilitation program. Nevertheless, the sample mainly consisted of a niche group of frail patients undergoing minimally invasive surgery under very specific context of care. Hence, the results may not be generalizable, and more trials have to be conducted to have a conclusive finding. Next, a multi-center, single-blinded RCT involving frail older patients from two university hospitals undergoing elective colorectal cancer surgery demonstrated minimal effects despite implementing tailored prehabilitation interventions[148]. Compared to control group, the rate of Grade II-V complications, readmission or mortality were not significantly reduced in the intervention group, only experiencing fewer less severe complications. Even though this study did carry out preoperative geriatric assessment, the authors acknowledged that the absence of a multi-professional team could have led to the formulation of interventions that were suboptimal in improving preoperative physical functions. In addition, the median intervention time was reduced from the initial stipulated duration of 21 d to only 6 d, which could have drastically affected the outcome. Hence, the validity of the results must be carefully scrutinized, and these limitations have to be circumvented to evaluate the profound effects of prehabilitation on these group of patients.

The studies interrogating the impact of prehabilitation on surgical outcomes in sarcopenic patients are limited. In a pilot study, the authors evaluated a preoperative exercise and nutritional support program for gastric cancer patients with sarcopenia undergoing gastrectomy[149]. After the completion of the program, the sarcopenic patients exhibited an enhancement in functional capacity, with a significant increase in handgrip strength and a non-significant improvement in gait speed with increased muscle mass index. Four patients became non-sarcopenic before surgery after an increase in their body weight and handgrip strength were observed, indicating the beneficial effect of the program. However, postoperative complications were not significantly different between both the enrolled sarcopenic and non-sarcopenic control patients. Nevertheless, the authors acknowledged that a well-designed RCT is needed to circumvent the small sample size, lack of a control group and the program framework for the results to be conclusive. In another study that can further rationalize the need for a prehabilitation regime demonstrated that perioperative oral nutritional supplementation decreased prevalence of sarcopenia following radical cystectomy compared to multivitamin control group[150]. The number of sarcopenic patients did not increase during the preoperative period for those that received oral supplementation whereas there was a significant increase of 20% for the control group. Postoperatively, there was a trend towards a lower incidence of complications and readmissions, but the result was not statistically significant. Overall, further evidence from larger RCTs is mandatory to not only investigate the effects of personalized prehabilitation program and surgical outcomes in high-risk patients, but also to optimize the process in carrying out preoperative geriatric assessment and the parameters of the program.

RESOURCE ALLOCATION TO OPTIMISE HEALTHCARE VALUE-DRIVEN OUTCOMES

The above has demonstrated overwhelming evidence of the utility and benefit of prehabilitation. However, should it be applied for everyone - a one-size-fit-all? Statistics from America demonstrates a worrying trend of exponential healthcare spending, which is showing no signs of relenting. In order to yield maximum benefit from the money spent coordinating and executing prehabilitation programs, the authors opine that it may actually benefit patient groups with the most risks of morbidity and mortality, such as those with sarcopenia or frailty. Frailty is a state of functional decline due to the loss of muscle mass[151]. Age-related sarcopenia is a multi-organ process that lead to a loss of skeletal muscle mass with a resultant decline in physical functions[152,153]. A recent news article suggested that the onset of sarcopenia may be as early as from the fifth decade of life. Along with the patients’ comorbidity burden, these would negatively affect surgical outcomes, resulting in increased complication rates and a higher propensity of delay to return to baseline[154-157]. These would naturally result in higher healthcare costs.

Even though nutrition and resistant training have shown positive effects on sarcopenia, the process and regulatory mechanisms of sarcopenia is poorly understood[158,159]. Needless to say, how these interventions affect the mechanism of sarcopenia is much less well understood. Thus, a multi-modal, multi-disciplinary tailored prehabilitation program, equipped with military-like precision and coordination, will be well-poised to optimize these higher risks patients before their surgeries. This is only feasible with adequate funding by hospital administration or governmental level healthcare funding.

There has yet to be convincing evidence that prehabilitation in a high-risk patient group would definitely translate to cost efficiency. A recent systemic review of prehabilitation in frail surgical patients was not able to conclude cost effectiveness as there were only 5 studies isolated[160]. However, the study recommended that frailty assessment should still be included in the recruitment into prehabilitation and that such a program would lessen operative risk. One can extrapolate that by focusing on high-risk patient groups, those that would be anticipated to require more healthcare resources than those who are healthy, there will be a higher chance of improving their baseline physiology in the short time before to their procedure[161,162]. This, in turn, would potentially have the largest clinical difference post-operatively amongst all other patient groups. Therefore, in terms of resource allocation, it would make most sense to focus on those who are of highest risk of surgical morbidity.

HOW TO MAKE EXISTING PREHABILITATION EVEN BETTER?

The identification of patients who will benefit from prehabilitation requires improvement from all fronts. Clinicians, especially the surgeons, will require a mindset change from a rehabilitation-centric focus to that of prehabilitation. Surgeons will not only need to embrace the fact that surgery might be delayed due to prehabilitation, but more importantly, be active in looking out for patients who will actually benefit from it. The underlying objective is to optimize their baseline function prior to surgery with the intention of reducing postoperative risks, improving surgical, oncological and patient-reported outcomes like quality-of-life. In order to assist clinicians to identify such patients, a consensus set of biomarkers derived from sound scientific and clinical evidence is required. At the moment, such a list of biomarkers is varied and non-specific, being only able to correlate with sarcopenia or frailty, but unable to concurrently correlate with postoperative outcomes[163-165]. Large scale investigations are required to unravel novel findings that can associate quantifiable biomarkers from patients such as muscle and functional health with surgical outcomes[166]. It is anticipated that a panel of functional and biochemical markers coupled with a receiver operating characteristic curve may eventually provide the most ideal predictive model. Having a simple yet accurate way of identifying patients who will benefit most from prehabilitation allows resources to be properly allocated. With this pragmatic approach in driving up the value of the program, it will have a better opportunity to be supported by various government-level or hospital-level administration.

More studies are required to integrate the different pillars of a multimodal prehabilitation program: Nutritional, physical and psychological interventions. This effort towards gaining a more in-depth understanding must go beyond that of just clinical studies. For example, how these interventions modulate molecular and genetic levels in muscle cells may be key to bringing us closer to revealing the optimal type of nutrition and exercise for prehabilitation. Equipped with this new knowledge, the surgical team would be better prepared to personalize and individualize prehabilitation to suit the needs of high-risk patients in this program.

Healthcare has advanced dramatically in the last 2 decades. Technology has become a well-incorporated cog of scientific and clinical practice. Pertinent to this discussion, deep machine learning, or artificial intelligence (AI), has been well recognized to have outperformed clinicians in some aspects of clinical practice[167-172]. AI may well have a role to play in the identification, customization and monitoring patients in prehabilitation. What is crucial in deep machine learning is the vastness of clinical data which is best obtained from a varied patient population, through international, multi-center collaboration. Other vital technology that we need to learn to adopt for such a program may be applications, or “apps”, on personal smartphones or wearable devices. In 2020, more than 96% of the United States population owned a smartphone, including 95% of those in the lowest socioeconomic class[173]. In 2019, statistics from the United States shows that 56% of the population has at least one wearable device, with a further 13% keen to invest in such a device in 2020[174]. Apps on such devices not only act as a personal assistant to the patient or family to coordinate consultation hospital visits, but also to support the clinical team in monitoring patient’s compliance to diet and exercise regimes. The seamless coordination between the patients and healthcare professionals is an important aspect to achieve compliance, which would determine the success of such a program. Inevitably, patient embarking on such a rigorous program will have numerous appointments with reviewing clinicians, dietetics, physiotherapies and pre-anesthetic assessments. Prompts from such apps can help motivate patients and provide feedback to the clinical team, enabling appropriate mediation when necessary. Such early attempts to improve the patients’ compliance during this trying time will improve health outcome leading up to major procedure

CONCLUSION

The world population is aging at an unprecedented rate concomitant with a remarkable increase in life expectancy. It is not surprising that the geriatric surgical population is also rapidly growing, and hence, clinicians have to take into account additional risk factors, such as frailty. In particular, it is evident that sarcopenia is an independent predictive factor of postoperative outcomes that has to be mitigated prior to surgery. Prehabilitation represents a paradigm shift in geriatric surgical care, with the goal of enhancing functional capacity to withstand a forthcoming stressor. Emerging data has inspired healthcare professionals to not only adopt a multimodal approach, but also to pivot towards personalized programs. We have reviewed the synergistic effect of the various pillars in improving surgical outcomes in high-risk patients. Nevertheless, it is mandatory to further optimized these programs by carrying out well-designed, multicenter, prospective study. In addition, it is vital that clinicians continue to work closely with scientists to unravel the signaling networks driving the progression of sarcopenia and mechanistic underpinnings of each intervention. These strategies will allow novel prehabilitation programs to be formulated that can be customized for each patient.

Footnotes

Manuscript source: Invited manuscript

Specialty type: Surgery

Country/Territory of origin: Singapore

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): 0

Grade C (Good): C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Grosek J S-Editor: Liu M L-Editor: Filipodia P-Editor: Li JH

References
1.  Finnerty CC, Mabvuure NT, Ali A, Kozar RA, Herndon DN. The surgically induced stress response. JPEN J Parenter Enteral Nutr. 2013;37:21S-29S.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 170]  [Cited by in F6Publishing: 197]  [Article Influence: 19.7]  [Reference Citation Analysis (0)]
2.  Smeuninx B, Elhassan YS, Manolopoulos KN, Sapey E, Rushton AB, Edwards SJ, Morgan PT, Philp A, Brook MS, Gharahdaghi N, Smith K, Atherton PJ, Breen L. The effect of short-term exercise prehabilitation on skeletal muscle protein synthesis and atrophy during bed rest in older men. J Cachexia Sarcopenia Muscle. 2021;12:52-69.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 22]  [Article Influence: 7.3]  [Reference Citation Analysis (0)]
3.  Sukharamwala P, Thoens J, Szuchmacher M, Smith J, DeVito P. Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB (Oxford). 2012;14:649-657.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 108]  [Cited by in F6Publishing: 113]  [Article Influence: 9.4]  [Reference Citation Analysis (0)]
4.  Massarweh NN, Legner VJ, Symons RG, McCormick WC, Flum DR. Impact of advancing age on abdominal surgical outcomes. Arch Surg. 2009;144:1108-1114.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 104]  [Cited by in F6Publishing: 114]  [Article Influence: 7.6]  [Reference Citation Analysis (0)]
5.  Lee SY, Lee SH, Tan JHH, Foo HSL, Phan PH, Kow AWC, Lwin S, Seah PMY, Mordiffi SZ. Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review. BMC Health Serv Res. 2018;18:5.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 16]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
6.  Collins TC, Daley J, Henderson WH, Khuri SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg. 1999;230:251-259.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 299]  [Cited by in F6Publishing: 348]  [Article Influence: 13.9]  [Reference Citation Analysis (0)]
7.  Narici MV, Maffulli N. Sarcopenia: characteristics, mechanisms and functional significance. Br Med Bull. 2010;95:139-159.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 449]  [Cited by in F6Publishing: 448]  [Article Influence: 32.0]  [Reference Citation Analysis (0)]
8.  Meyer C, Dostou JM, Welle SL, Gerich JE. Role of human liver, kidney, and skeletal muscle in postprandial glucose homeostasis. Am J Physiol Endocrinol Metab. 2002;282:E419-E427.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 180]  [Cited by in F6Publishing: 172]  [Article Influence: 7.8]  [Reference Citation Analysis (0)]
9.  Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84:475-482.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 887]  [Cited by in F6Publishing: 891]  [Article Influence: 49.5]  [Reference Citation Analysis (0)]
10.  Huang DD, Wang SL, Zhuang CL, Zheng BS, Lu JX, Chen FF, Zhou CJ, Shen X, Yu Z. Sarcopenia, as defined by low muscle mass, strength and physical performance, predicts complications after surgery for colorectal cancer. Colorectal Dis. 2015;17:O256-O264.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 141]  [Cited by in F6Publishing: 154]  [Article Influence: 17.1]  [Reference Citation Analysis (0)]
11.  Jochum SB, Kistner M, Wood EH, Hoscheit M, Nowak L, Poirier J, Eberhardt JM, Saclarides TJ, Hayden DM. Is sarcopenia a better predictor of complications than body mass index? Colorectal Dis. 2019;21:1372-1378.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 26]  [Cited by in F6Publishing: 41]  [Article Influence: 8.2]  [Reference Citation Analysis (0)]
12.  Dolan DR, Knight KA, Maguire S, Moug SJ. The relationship between sarcopenia and survival at 1 year in patients having elective colorectal cancer surgery. Tech Coloproctol. 2019;23:877-885.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 29]  [Article Influence: 5.8]  [Reference Citation Analysis (0)]
13.  Hua H, Xu X, Tang Y, Ren Z, Xu Q, Chen L. Effect of sarcopenia on clinical outcomes following digestive carcinoma surgery: a meta-analysis. Support Care Cancer. 2019;27:2385-2394.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 24]  [Cited by in F6Publishing: 19]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]
14.  Pipek LZ, Baptista CG, Nascimento RFV, Taba JV, Suzuki MO, do Nascimento FS, Martines DR, Nii F, Iuamoto LR, Carneiro-D'Albuquerque LA, Meyer A, Andraus W. The impact of properly diagnosed sarcopenia on postoperative outcomes after gastrointestinal surgery: A systematic review and meta-analysis. PLoS One. 2020;15:e0237740.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 30]  [Article Influence: 7.5]  [Reference Citation Analysis (0)]
15.  Antoniou GA, Rojoa D, Antoniou SA, Alfahad A, Torella F, Juszczak MT. Effect of Low Skeletal Muscle Mass on Post-operative Survival of Patients With Abdominal Aortic Aneurysm: A Prognostic Factor Review and Meta-Analysis of Time-to-Event Data. Eur J Vasc Endovasc Surg. 2019;58:190-198.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 26]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
16.  Choi MH, Yoon SB, Lee K, Song M, Lee IS, Lee MA, Hong TH, Choi MG. Preoperative sarcopenia and post-operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer. J Cachexia Sarcopenia Muscle. 2018;9:326-334.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 74]  [Cited by in F6Publishing: 92]  [Article Influence: 15.3]  [Reference Citation Analysis (1)]
17.  Okamura H, Kimura N, Tanno K, Mieno M, Matsumoto H, Yamaguchi A, Adachi H. The impact of preoperative sarcopenia, defined based on psoas muscle area, on long-term outcomes of heart valve surgery. J Thorac Cardiovasc Surg. 2019;157:1071-1079.e3.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 37]  [Cited by in F6Publishing: 44]  [Article Influence: 8.8]  [Reference Citation Analysis (0)]
18.  Ikeno Y, Koide Y, Abe N, Matsueda T, Izawa N, Yamazato T, Miyahara S, Nomura Y, Sato S, Takahashi H, Inoue T, Matsumori M, Tanaka H, Ishihara S, Nakayama S, Sugimoto K, Okita Y. Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly†. Eur J Cardiothorac Surg. 2017;51:1135-1141.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 25]  [Article Influence: 3.6]  [Reference Citation Analysis (0)]
19.  Bibas L, Saleh E, Al-Kharji S, Chetrit J, Mullie L, Cantarovich M, Cecere R, Giannetti N, Afilalo J. Muscle Mass and Mortality After Cardiac Transplantation. Transplantation. 2018;102:2101-2107.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 19]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]
20.  Nakamura R, Inage Y, Tobita R, Yoneyama S, Numata T, Ota K, Yanai H, Endo T, Inadome Y, Sakashita S, Satoh H, Yuzawa K, Terashima T. Sarcopenia in Resected NSCLC: Effect on Postoperative Outcomes. J Thorac Oncol. 2018;13:895-903.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 67]  [Cited by in F6Publishing: 81]  [Article Influence: 13.5]  [Reference Citation Analysis (0)]
21.  Deng HY, Hou L, Zha P, Huang KL, Peng L. Sarcopenia is an independent unfavorable prognostic factor of non-small cell lung cancer after surgical resection: A comprehensive systematic review and meta-analysis. Eur J Surg Oncol. 2019;45:728-735.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 53]  [Article Influence: 10.6]  [Reference Citation Analysis (0)]
22.  Fearon KC, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery. Proc Nutr Soc. 2003;62:807-811.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 98]  [Cited by in F6Publishing: 102]  [Article Influence: 5.1]  [Reference Citation Analysis (0)]
23.  Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, Nygren J, Hausel J, Soop M, Andersen J, Kehlet H. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466-477.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1001]  [Cited by in F6Publishing: 924]  [Article Influence: 48.6]  [Reference Citation Analysis (0)]
24.  van Dam RM, Hendry PO, Coolsen MM, Bemelmans MH, Lassen K, Revhaug A, Fearon KC, Garden OJ, Dejong CH;  Enhanced Recovery After Surgery (ERAS) Group. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg. 2008;95:969-975.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 161]  [Cited by in F6Publishing: 172]  [Article Influence: 10.8]  [Reference Citation Analysis (0)]
25.  Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schäfer M, Parks RW, Fearon KC, Lobo DN, Demartines N, Braga M, Ljungqvist O, Dejong CH;  Enhanced Recovery After Surgery (ERAS) Society; for Perioperative Care;  European Society for Clinical Nutrition and Metabolism (ESPEN);  International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37:240-258.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 260]  [Cited by in F6Publishing: 276]  [Article Influence: 23.0]  [Reference Citation Analysis (1)]
26.  Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, Carli F, Demartines N, Griffin SM, Lassen K;  Enhanced Recovery After Surgery (ERAS®) Group. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg. 2014;101:1209-1229.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 386]  [Cited by in F6Publishing: 432]  [Article Influence: 43.2]  [Reference Citation Analysis (0)]
27.  Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K, Andersen J, Kessels AG, Revhaug A, Kehlet H, Ljungqvist O, Fearon KC, von Meyenfeldt MF. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg. 2007;94:224-231.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 382]  [Cited by in F6Publishing: 354]  [Article Influence: 20.8]  [Reference Citation Analysis (0)]
28.  Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J;  Enhanced Recovery After Surgery Study Group. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011;146:571-577.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 570]  [Cited by in F6Publishing: 550]  [Article Influence: 42.3]  [Reference Citation Analysis (0)]
29.  Wolk S, Distler M, Müssle B, Söthje S, Weitz J, Welsch T. Adherence to ERAS elements in major visceral surgery-an observational pilot study. Langenbecks Arch Surg. 2016;401:349-356.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 16]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
30.  Roulin D, Melloul E, Wellg BE, Izbicki J, Vrochides D, Adham M, Hübner M, Demartines N. Feasibility of an Enhanced Recovery Protocol for Elective Pancreatoduodenectomy: A Multicenter International Cohort Study. World J Surg. 2020;44:2761-2769.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 23]  [Article Influence: 5.8]  [Reference Citation Analysis (0)]
31.  Seow-En I, Wu J, Yang LWY, Tan JSQ, Seah AWH, Foo FJ, Chang M, Tang CL, Tan EKW. Results of a colorectal enhanced recovery after surgery (ERAS) programme and a qualitative analysis of healthcare workers' perspectives. Asian J Surg. 2021;44:307-312.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 16]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
32.  Gianotti L, Fumagalli Romario U, De Pascale S, Weindelmayer J, Mengardo V, Sandini M, Cossu A, Parise P, Rosati R, Bencini L, Coratti A, Colombo G, Galli F, Rausei S, Casella F, Sansonetti A, Maggioni D, Costanzi A, Bernasconi DP, De Manzoni G. Association Between Compliance to an Enhanced Recovery Protocol and Outcome After Elective Surgery for Gastric Cancer. Results from a Western Population-Based Prospective Multicenter Study. World J Surg. 2019;43:2490-2498.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 29]  [Cited by in F6Publishing: 27]  [Article Influence: 5.4]  [Reference Citation Analysis (0)]
33.  Meillat H, Brun C, Zemmour C, de Chaisemartin C, Turrini O, Faucher M, Lelong B. Laparoscopy is not enough: full ERAS compliance is the key to improvement of short-term outcomes after colectomy for cancer. Surg Endosc. 2020;34:2067-2075.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 16]  [Article Influence: 3.2]  [Reference Citation Analysis (1)]
34.  Kitahata Y, Hirono S, Kawai M, Okada KI, Miyazawa M, Shimizu A, Kobayashi R, Ueno M, Hayami S, Shimokawa T, Kouda K, Tajima F, Yamaue H. Intensive perioperative rehabilitation improves surgical outcomes after pancreaticoduodenectomy. Langenbecks Arch Surg. 2018;403:711-718.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 15]  [Article Influence: 2.5]  [Reference Citation Analysis (0)]
35.  Wang Q, Suo J, Jiang J, Wang C, Zhao YQ, Cao X. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial. Colorectal Dis. 2012;14:1009-1013.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 120]  [Cited by in F6Publishing: 116]  [Article Influence: 9.7]  [Reference Citation Analysis (0)]
36.  Bardram L, Funch-Jensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection. Br J Surg. 2000;87:1540-1545.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 124]  [Cited by in F6Publishing: 132]  [Article Influence: 5.5]  [Reference Citation Analysis (0)]
37.  Loughney L, Cahill R, O'Malley K, McCaffrey N, Furlong B. Compliance, adherence and effectiveness of a community-based pre-operative exercise programme: a pilot study. Perioper Med (Lond). 2019;8:17.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 9]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
38.  Ferreira V, Agnihotram RV, Bergdahl A, van Rooijen SJ, Awasthi R, Carli F, Scheede-Bergdahl C. Maximizing patient adherence to prehabilitation: what do the patients say? Support Care Cancer. 2018;26:2717-2723.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 61]  [Cited by in F6Publishing: 47]  [Article Influence: 7.8]  [Reference Citation Analysis (0)]
39.  Hijazi Y, Gondal U, Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg. 2017;39:156-162.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 141]  [Cited by in F6Publishing: 159]  [Article Influence: 22.7]  [Reference Citation Analysis (0)]
40.  Carli F, Bousquet-Dion G, Awasthi R, Elsherbini N, Liberman S, Boutros M, Stein B, Charlebois P, Ghitulescu G, Morin N, Jagoe T, Scheede-Bergdahl C, Minnella EM, Fiore JF Jr. Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer: A Randomized Clinical Trial. JAMA Surg. 2020;155:233-242.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 138]  [Cited by in F6Publishing: 226]  [Article Influence: 56.5]  [Reference Citation Analysis (0)]
41.  Iida Y, Yamazaki T, Arima H, Kawabe T, Yamada S. Predictors of surgery-induced muscle proteolysis in patients undergoing cardiac surgery. J Cardiol. 2016;68:536-541.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 15]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
42.  Margraf A, Ludwig N, Zarbock A, Rossaint J. Systemic Inflammatory Response Syndrome After Surgery: Mechanisms and Protection. Anesth Analg. 2020;131:1693-1707.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 35]  [Cited by in F6Publishing: 65]  [Article Influence: 16.3]  [Reference Citation Analysis (0)]
43.  Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118:317-334.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 324]  [Cited by in F6Publishing: 435]  [Article Influence: 62.1]  [Reference Citation Analysis (0)]
44.  Fu MC, Buerba RA, Grauer JN. Preoperative Nutritional Status as an Adjunct Predictor of Major Postoperative Complications Following Anterior Cervical Discectomy and Fusion. Clin Spine Surg. 2016;29:167-172.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 44]  [Cited by in F6Publishing: 51]  [Article Influence: 6.4]  [Reference Citation Analysis (0)]
45.  van der Kroft G, Janssen-Heijnen MLG, van Berlo CLH, Konsten JLM. Evaluation of nutritional status as an independent predictor of post-operative complications and morbidity after gastro-intestinal surgery. Clin Nutr ESPEN. 2015;10:e129-e133.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 7]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
46.  Delgado-Rodríguez M, Medina-Cuadros M, Gómez-Ortega A, Martínez-Gallego G, Mariscal-Ortiz M, Martinez-Gonzalez MA, Sillero-Arenas M. Cholesterol and serum albumin levels as predictors of cross infection, death, and length of hospital stay. Arch Surg. 2002;137:805-812.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 78]  [Article Influence: 3.5]  [Reference Citation Analysis (0)]
47.  Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134:36-42.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 672]  [Cited by in F6Publishing: 601]  [Article Influence: 24.0]  [Reference Citation Analysis (0)]
48.  Lambert JW, Ingham M, Gibbs BB, Given RW, Lance RS, Riggs SB. Using preoperative albumin levels as a surrogate marker for outcomes after radical cystectomy for bladder cancer. Urology. 2013;81:587-592.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 61]  [Cited by in F6Publishing: 70]  [Article Influence: 6.4]  [Reference Citation Analysis (0)]
49.  Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014;96:15-22.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 157]  [Cited by in F6Publishing: 131]  [Article Influence: 13.1]  [Reference Citation Analysis (0)]
50.  Lende TH, Austdal M, Varhaugvik AE, Skaland I, Gudlaugsson E, Kvaløy JT, Akslen LA, Søiland H, Janssen EAM, Baak JPA. Influence of pre-operative oral carbohydrate loading vs. standard fasting on tumor proliferation and clinical outcome in breast cancer patients ─ a randomized trial. BMC Cancer. 2019;19:1076.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 6]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
51.  Ng TP, Lu Y, Choo RWM, Tan CTY, Nyunt MSZ, Gao Q, Mok EWH, Larbi A. Dysregulated homeostatic pathways in sarcopenia among frail older adults. Aging Cell. 2018;17:e12842.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 20]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
52.  Norton LE, Layman DK. Leucine regulates translation initiation of protein synthesis in skeletal muscle after exercise. J Nutr. 2006;136:533S-537S.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 180]  [Cited by in F6Publishing: 173]  [Article Influence: 9.6]  [Reference Citation Analysis (0)]
53.  Layman DK. Role of leucine in protein metabolism during exercise and recovery. Can J Appl Physiol. 2002;27:646-663.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 62]  [Cited by in F6Publishing: 63]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
54.  Nair KS, Schwartz RG, Welle S. Leucine as a regulator of whole body and skeletal muscle protein metabolism in humans. Am J Physiol. 1992;263:E928-E934.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 58]  [Cited by in F6Publishing: 91]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
55.  Louard RJ, Barrett EJ, Gelfand RA. Effect of infused branched-chain amino acids on muscle and whole-body amino acid metabolism in man. Clin Sci (Lond). 1990;79:457-466.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 120]  [Cited by in F6Publishing: 124]  [Article Influence: 3.6]  [Reference Citation Analysis (0)]
56.  Bellanti F, Romano AD, Lo Buglio A, Castriotta V, Guglielmi G, Greco A, Serviddio G, Vendemiale G. Oxidative stress is increased in sarcopenia and associated with cardiovascular disease risk in sarcopenic obesity. Maturitas. 2018;109:6-12.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 75]  [Cited by in F6Publishing: 71]  [Article Influence: 11.8]  [Reference Citation Analysis (0)]
57.  Kücükakin B, Gögenur I, Reiter RJ, Rosenberg J. Oxidative stress in relation to surgery: is there a role for the antioxidant melatonin? J Surg Res. 2009;152:338-347.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 51]  [Article Influence: 3.4]  [Reference Citation Analysis (0)]
58.  Senoner T, Schindler S, Stättner S, Öfner D, Troppmair J, Primavesi F. Associations of Oxidative Stress and Postoperative Outcome in Liver Surgery with an Outlook to Future Potential Therapeutic Options. Oxid Med Cell Longev. 2019;2019:3950818.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 28]  [Cited by in F6Publishing: 32]  [Article Influence: 6.4]  [Reference Citation Analysis (0)]
59.  Gilmartin S, O'Brien N, Giblin L. Whey for Sarcopenia; Can Whey Peptides, Hydrolysates or Proteins Play a Beneficial Role? Foods. 2020;9:750.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 22]  [Article Influence: 5.5]  [Reference Citation Analysis (0)]
60.  Rong YD, Bian AL, Hu HY, Ma Y, Zhou XZ. Study on relationship between elderly sarcopenia and inflammatory cytokine IL-6, anti-inflammatory cytokine IL-10. BMC Geriatr. 2018;18:308.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 79]  [Cited by in F6Publishing: 115]  [Article Influence: 19.2]  [Reference Citation Analysis (0)]
61.  Bian AL, Hu HY, Rong YD, Wang J, Wang JX, Zhou XZ. A study on relationship between elderly sarcopenia and inflammatory factors IL-6 and TNF-α. Eur J Med Res. 2017;22:25.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 106]  [Cited by in F6Publishing: 155]  [Article Influence: 22.1]  [Reference Citation Analysis (0)]
62.  Kwak JY, Hwang H, Kim SK, Choi JY, Lee SM, Bang H, Kwon ES, Lee KP, Chung SG, Kwon KS. Prediction of sarcopenia using a combination of multiple serum biomarkers. Sci Rep. 2018;8:8574.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 37]  [Cited by in F6Publishing: 39]  [Article Influence: 6.5]  [Reference Citation Analysis (0)]
63.  Yamaguchi M, Yoshida K, Uchida M. Novel functions of bovine milk-derived alpha-lactalbumin: anti-nociceptive and anti-inflammatory activity caused by inhibiting cyclooxygenase-2 and phospholipase A2. Biol Pharm Bull. 2009;32:366-371.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 43]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
64.  Mattsby-Baltzer I, Roseanu A, Motas C, Elverfors J, Engberg I, Hanson LA. Lactoferrin or a fragment thereof inhibits the endotoxin-induced interleukin-6 response in human monocytic cells. Pediatr Res. 1996;40:257-262.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 138]  [Cited by in F6Publishing: 131]  [Article Influence: 4.7]  [Reference Citation Analysis (0)]
65.  Srikanthan P, Hevener AL, Karlamangla AS. Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the National Health and Nutrition Examination Survey III. PLoS One. 2010;5:e10805.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 360]  [Cited by in F6Publishing: 400]  [Article Influence: 28.6]  [Reference Citation Analysis (0)]
66.  Moon SS. Low skeletal muscle mass is associated with insulin resistance, diabetes, and metabolic syndrome in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2010. Endocr J. 2014;61:61-70.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 175]  [Cited by in F6Publishing: 185]  [Article Influence: 18.5]  [Reference Citation Analysis (0)]
67.  Ida S, Kaneko R, Imataka K, Murata K. Association between Sarcopenia and Renal Function in Patients with Diabetes: A Systematic Review and Meta-Analysis. J Diabetes Res. 2019;2019:1365189.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 17]  [Article Influence: 3.4]  [Reference Citation Analysis (0)]
68.  Lee SW, Youm Y, Lee WJ, Choi W, Chu SH, Park YR, Kim HC. Appendicular skeletal muscle mass and insulin resistance in an elderly korean population: the korean social life, health and aging project-health examination cohort. Diabetes Metab J. 2015;39:37-45.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 81]  [Article Influence: 9.0]  [Reference Citation Analysis (0)]
69.  Sato H, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T. The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. J Clin Endocrinol Metab. 2010;95:4338-4344.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 209]  [Cited by in F6Publishing: 198]  [Article Influence: 14.1]  [Reference Citation Analysis (0)]
70.  Pillinger NL, Robson JL, Kam P. Nutritional prehabilitation: physiological basis and clinical evidence. Anaesth Intensive Care. 2018;46:453-462.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 20]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
71.  Perrone F, da-Silva-Filho AC, Adôrno IF, Anabuki NT, Leal FS, Colombo T, da Silva BD, Dock-Nascimento DB, Damião A, de Aguilar-Nascimento JE. Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial. Nutr J. 2011;10:66.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 57]  [Article Influence: 4.4]  [Reference Citation Analysis (0)]
72.  Wang ZG, Wang Q, Wang WJ, Qin HL. Randomized clinical trial to compare the effects of preoperative oral carbohydrate vs placebo on insulin resistance after colorectal surgery. Br J Surg. 2010;97:317-327.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 108]  [Cited by in F6Publishing: 114]  [Article Influence: 8.1]  [Reference Citation Analysis (0)]
73.  Yuill KA, Richardson RA, Davidson HI, Garden OJ, Parks RW. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively--a randomised clinical trial. Clin Nutr. 2005;24:32-37.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 178]  [Cited by in F6Publishing: 166]  [Article Influence: 8.7]  [Reference Citation Analysis (0)]
74.  Dzik KP, Kaczor JJ. Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state. Eur J Appl Physiol. 2019;119:825-839.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 99]  [Cited by in F6Publishing: 133]  [Article Influence: 26.6]  [Reference Citation Analysis (0)]
75.  Gil Á, Plaza-Diaz J, Mesa MD. Vitamin D: Classic and Novel Actions. Ann Nutr Metab. 2018;72:87-95.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 211]  [Cited by in F6Publishing: 227]  [Article Influence: 37.8]  [Reference Citation Analysis (0)]
76.  Boucher BJ. The problems of vitamin d insufficiency in older people. Aging Dis. 2012;3:313-329.  [PubMed]  [DOI]  [Cited in This Article: ]
77.  Boettger SF, Angersbach B, Klimek CN, Wanderley ALM, Shaibekov A, Sieske L, Wang B, Zuchowski M, Wirth R, Pourhassan M. Prevalence and predictors of vitamin D-deficiency in frail older hospitalized patients. BMC Geriatr. 2018;18:219.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 20]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
78.  Dzik KP, Skrobot W, Kaczor KB, Flis DJ, Karnia MJ, Libionka W, Antosiewicz J, Kloc W, Kaczor JJ. Vitamin D Deficiency Is Associated with Muscle Atrophy and Reduced Mitochondrial Function in Patients with Chronic Low Back Pain. Oxid Med Cell Longev. 2019;2019:6835341.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 22]  [Article Influence: 4.4]  [Reference Citation Analysis (0)]
79.  Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, McMurdo ME, Mets T, Seal C, Wijers SL, Ceda GP, De Vito G, Donders G, Drey M, Greig C, Holmbäck U, Narici M, McPhee J, Poggiogalle E, Power D, Scafoglieri A, Schultz R, Sieber CC, Cederholm T. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2015;16:740-747.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 378]  [Cited by in F6Publishing: 391]  [Article Influence: 43.4]  [Reference Citation Analysis (0)]
80.  Muir SW, Montero-Odasso M. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2011;59:2291-2300.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 305]  [Cited by in F6Publishing: 327]  [Article Influence: 25.2]  [Reference Citation Analysis (0)]
81.  Smith GI, Atherton P, Reeds DN, Mohammed BS, Rankin D, Rennie MJ, Mittendorfer B. Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia-hyperaminoacidaemia in healthy young and middle-aged men and women. Clin Sci (Lond). 2011;121:267-278.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 218]  [Cited by in F6Publishing: 233]  [Article Influence: 17.9]  [Reference Citation Analysis (0)]
82.  Smith GI, Atherton P, Reeds DN, Mohammed BS, Rankin D, Rennie MJ, Mittendorfer B. Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr. 2011;93:402-412.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 437]  [Cited by in F6Publishing: 405]  [Article Influence: 31.2]  [Reference Citation Analysis (0)]
83.  Verlaan S, Aspray TJ, Bauer JM, Cederholm T, Hemsworth J, Hill TR, McPhee JS, Piasecki M, Seal C, Sieber CC, Ter Borg S, Wijers SL, Brandt K. Nutritional status, body composition, and quality of life in community-dwelling sarcopenic and non-sarcopenic older adults: A case-control study. Clin Nutr. 2017;36:267-274.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 127]  [Cited by in F6Publishing: 137]  [Article Influence: 19.6]  [Reference Citation Analysis (0)]
84.  Mafi F, Biglari S, Ghardashi Afousi A, Gaeini AA. Improvement in Skeletal Muscle Strength and Plasma Levels of Follistatin and Myostatin Induced by an 8-Week Resistance Training and Epicatechin Supplementation in Sarcopenic Older Adults. J Aging Phys Act. 2019;27:384-391.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 23]  [Cited by in F6Publishing: 26]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
85.  Andreux PA, Blanco-Bose W, Ryu D, Burdet F, Ibberson M, Aebischer P, Auwerx J, Singh A, Rinsch C. The mitophagy activator urolithin A is safe and induces a molecular signature of improved mitochondrial and cellular health in humans. Nat Metab. 2019;1:595-603.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 232]  [Cited by in F6Publishing: 266]  [Article Influence: 53.2]  [Reference Citation Analysis (0)]
86.  Bori Z, Zhao Z, Koltai E, Fatouros IG, Jamurtas AZ, Douroudos II, Terzis G, Chatzinikolaou A, Sovatzidis A, Draganidis D, Boldogh I, Radak Z. The effects of aging, physical training, and a single bout of exercise on mitochondrial protein expression in human skeletal muscle. Exp Gerontol. 2012;47:417-424.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 70]  [Cited by in F6Publishing: 61]  [Article Influence: 5.1]  [Reference Citation Analysis (0)]
87.  Chen HT, Chung YC, Chen YJ, Ho SY, Wu HJ. Effects of Different Types of Exercise on Body Composition, Muscle Strength, and IGF-1 in the Elderly with Sarcopenic Obesity. J Am Geriatr Soc. 2017;65:827-832.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 113]  [Cited by in F6Publishing: 121]  [Article Influence: 17.3]  [Reference Citation Analysis (0)]
88.  Harber MP, Konopka AR, Undem MK, Hinkley JM, Minchev K, Kaminsky LA, Trappe TA, Trappe S. Aerobic exercise training induces skeletal muscle hypertrophy and age-dependent adaptations in myofiber function in young and older men. J Appl Physiol (1985). 2012;113:1495-1504.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 124]  [Cited by in F6Publishing: 137]  [Article Influence: 11.4]  [Reference Citation Analysis (0)]
89.  Konopka AR, Douglass MD, Kaminsky LA, Jemiolo B, Trappe TA, Trappe S, Harber MP. Molecular adaptations to aerobic exercise training in skeletal muscle of older women. J Gerontol A Biol Sci Med Sci. 2010;65:1201-1207.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 70]  [Cited by in F6Publishing: 80]  [Article Influence: 5.7]  [Reference Citation Analysis (0)]
90.  Frøsig C, Jensen TE, Jeppesen J, Pehmøller C, Treebak JT, Maarbjerg SJ, Kristensen JM, Sylow L, Alsted TJ, Schjerling P, Kiens B, Wojtaszewski JF, Richter EA. AMPK and insulin action--responses to ageing and high fat diet. PLoS One. 2013;8:e62338.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 23]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
91.  Kramer HF, Goodyear LJ. Exercise, MAPK, and NF-kappaB signaling in skeletal muscle. J Appl Physiol (1985). 2007;103:388-395.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 234]  [Cited by in F6Publishing: 246]  [Article Influence: 14.5]  [Reference Citation Analysis (0)]
92.  Radak Z, Suzuki K, Posa A, Petrovszky Z, Koltai E, Boldogh I. The systemic role of SIRT1 in exercise mediated adaptation. Redox Biol. 2020;35:101467.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 26]  [Cited by in F6Publishing: 40]  [Article Influence: 10.0]  [Reference Citation Analysis (0)]
93.  Radom-Aizik S, Hayek S, Shahar I, Rechavi G, Kaminski N, Ben-Dov I. Effects of aerobic training on gene expression in skeletal muscle of elderly men. Med Sci Sports Exerc. 2005;37:1680-1696.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 37]  [Cited by in F6Publishing: 35]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
94.  Gielen S, Sandri M, Kozarez I, Kratzsch J, Teupser D, Thiery J, Erbs S, Mangner N, Lenk K, Hambrecht R, Schuler G, Adams V. Exercise training attenuates MuRF-1 expression in the skeletal muscle of patients with chronic heart failure independent of age: the randomized Leipzig Exercise Intervention in Chronic Heart Failure and Aging catabolism study. Circulation. 2012;125:2716-2727.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 136]  [Cited by in F6Publishing: 143]  [Article Influence: 11.9]  [Reference Citation Analysis (0)]
95.  Short KR, Vittone JL, Bigelow ML, Proctor DN, Nair KS. Age and aerobic exercise training effects on whole body and muscle protein metabolism. Am J Physiol Endocrinol Metab. 2004;286:E92-101.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 308]  [Cited by in F6Publishing: 290]  [Article Influence: 14.5]  [Reference Citation Analysis (0)]
96.  Yan Z, Lira VA, Greene NP. Exercise training-induced regulation of mitochondrial quality. Exerc Sport Sci Rev. 2012;40:159-164.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 157]  [Cited by in F6Publishing: 158]  [Article Influence: 13.2]  [Reference Citation Analysis (0)]
97.  Negaresh R, Ranjbar R, Baker JS, Habibi A, Mokhtarzade M, Gharibvand MM, Fokin A. Skeletal Muscle Hypertrophy, Insulin-like Growth Factor 1, Myostatin and Follistatin in Healthy and Sarcopenic Elderly Men: The Effect of Whole-body Resistance Training. Int J Prev Med. 2019;10:29.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 26]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
98.  Lichtenberg T, von Stengel S, Sieber C, Kemmler W. The Favorable Effects of a High-Intensity Resistance Training on Sarcopenia in Older Community-Dwelling Men with Osteosarcopenia: The Randomized Controlled FrOST Study. Clin Interv Aging. 2019;14:2173-2186.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 50]  [Article Influence: 10.0]  [Reference Citation Analysis (0)]
99.  Martín Del Campo Cervantes J, Habacuc Macías Cervantes M, Monroy Torres R. Effect of a Resistance Training Program on Sarcopenia and Functionality of the Older Adults Living in a Nursing Home. J Nutr Health Aging. 2019;23:829-836.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 33]  [Cited by in F6Publishing: 23]  [Article Influence: 4.6]  [Reference Citation Analysis (0)]
100.  Goodman CA, Frey JW, Mabrey DM, Jacobs BL, Lincoln HC, You JS, Hornberger TA. The role of skeletal muscle mTOR in the regulation of mechanical load-induced growth. J Physiol. 2011;589:5485-5501.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 199]  [Cited by in F6Publishing: 211]  [Article Influence: 16.2]  [Reference Citation Analysis (0)]
101.  Drummond MJ, Dreyer HC, Fry CS, Glynn EL, Rasmussen BB. Nutritional and contractile regulation of human skeletal muscle protein synthesis and mTORC1 signaling. J Appl Physiol (1985). 2009;106:1374-1384.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 206]  [Cited by in F6Publishing: 213]  [Article Influence: 14.2]  [Reference Citation Analysis (0)]
102.  McFarlane C, Hui GZ, Amanda WZ, Lau HY, Lokireddy S, Xiaojia G, Mouly V, Butler-Browne G, Gluckman PD, Sharma M, Kambadur R. Human myostatin negatively regulates human myoblast growth and differentiation. Am J Physiol Cell Physiol. 2011;301:C195-C203.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 74]  [Cited by in F6Publishing: 80]  [Article Influence: 6.2]  [Reference Citation Analysis (0)]
103.  Takeshima N, Rogers ME, Islam MM, Yamauchi T, Watanabe E, Okada A. Effect of concurrent aerobic and resistance circuit exercise training on fitness in older adults. Eur J Appl Physiol. 2004;93:173-182.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 69]  [Cited by in F6Publishing: 59]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
104.  Adams SC, Segal RJ, McKenzie DC, Vallerand JR, Morielli AR, Mackey JR, Gelmon K, Friedenreich CM, Reid RD, Courneya KS. Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Breast Cancer Res Treat. 2016;158:497-507.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 88]  [Cited by in F6Publishing: 94]  [Article Influence: 11.8]  [Reference Citation Analysis (0)]
105.  Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol (1985). 2005;98:1154-1162.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1723]  [Cited by in F6Publishing: 1768]  [Article Influence: 93.1]  [Reference Citation Analysis (0)]
106.  de Sousa CV, Sales MM, Rosa TS, Lewis JE, de Andrade RV, Simões HG. The Antioxidant Effect of Exercise: A Systematic Review and Meta-Analysis. Sports Med. 2017;47:277-293.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 148]  [Cited by in F6Publishing: 119]  [Article Influence: 14.9]  [Reference Citation Analysis (0)]
107.  Levett DZH, Grimmett C. Psychological factors, prehabilitation and surgical outcomes: evidence and future directions. Anaesthesia. 2019;74 Suppl 1:36-42.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 86]  [Cited by in F6Publishing: 89]  [Article Influence: 17.8]  [Reference Citation Analysis (0)]
108.  Woo AK. Depression and Anxiety in Pain. Rev Pain. 2010;4:8-12.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 128]  [Cited by in F6Publishing: 146]  [Article Influence: 16.2]  [Reference Citation Analysis (0)]
109.  Gouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Crit Care Nurs Clin North Am. 2012;24:201-213.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 41]  [Article Influence: 3.4]  [Reference Citation Analysis (0)]
110.  Kitano Cp T, Kawakami M, Fukui D, Ishimoto Y, Nagata K, Yamada H, Nakagawa Y. Preoperative psychological factors affecting surgical satisfaction of elderly patients with lumbar spinal stenosis. J Orthop Sci. 2020;25:751-756.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 10]  [Article Influence: 2.5]  [Reference Citation Analysis (0)]
111.  Berian JR, Zhou L, Hornor MA, Russell MM, Cohen ME, Finlayson E, Ko CY, Robinson TN, Rosenthal RA. Optimizing Surgical Quality Datasets to Care for Older Adults: Lessons from the American College of Surgeons NSQIP Geriatric Surgery Pilot. J Am Coll Surg. 2017;225:702-712.e1.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 41]  [Cited by in F6Publishing: 42]  [Article Influence: 6.0]  [Reference Citation Analysis (0)]
112.  Tang VL, Jing B, Boscardin J, Ngo S, Silvestrini M, Finlayson E, Covinsky KE. Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery. JAMA Surg. 2020;155:412-418.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 41]  [Cited by in F6Publishing: 34]  [Article Influence: 8.5]  [Reference Citation Analysis (0)]
113.  Dent E, Hoogendijk EO. Psychosocial factors modify the association of frailty with adverse outcomes: a prospective study of hospitalised older people. BMC Geriatr. 2014;14:108.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 68]  [Cited by in F6Publishing: 78]  [Article Influence: 7.8]  [Reference Citation Analysis (0)]
114.  Taani MH, Siglinsky E, Kovach CR, Buehring B. Psychosocial Factors Associated With Reduced Muscle Mass, Strength, and Function in Residential Care Apartment Complex Residents. Res Gerontol Nurs. 2018;11:238-248.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 11]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
115.  van Rooijen S, Carli F, Dalton S, Thomas G, Bojesen R, Le Guen M, Barizien N, Awasthi R, Minnella E, Beijer S, Martínez-Palli G, van Lieshout R, Gögenur I, Feo C, Johansen C, Scheede-Bergdahl C, Roumen R, Schep G, Slooter G. Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation. BMC Cancer. 2019;19:98.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 176]  [Cited by in F6Publishing: 161]  [Article Influence: 32.2]  [Reference Citation Analysis (0)]
116.  Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Tolosa I, Vohra R. Psychological Prehabilitation Before Cancer Surgery: A Systematic Review. Ann Surg Oncol. 2015;22:4117-4123.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 135]  [Article Influence: 15.0]  [Reference Citation Analysis (0)]
117.  Santa Mina D, Alibhai SMH. Prehabilitation in geriatric oncology. J Geriatr Oncol. 2020;11:731-734.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 6]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
118.  Vailati Riboni F, Comazzi B, Bercovitz K, Castelnuovo G, Molinari E, Pagnini F. Technologically-enhanced psychological interventions for older adults: a scoping review. BMC Geriatr. 2020;20:191.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 9]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
119.  Wall BT, Gorissen SH, Pennings B, Koopman R, Groen BB, Verdijk LB, van Loon LJ. Aging Is Accompanied by a Blunted Muscle Protein Synthetic Response to Protein Ingestion. PLoS One. 2015;10:e0140903.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 189]  [Cited by in F6Publishing: 212]  [Article Influence: 23.6]  [Reference Citation Analysis (0)]
120.  Breen L, Phillips SM. Skeletal muscle protein metabolism in the elderly: Interventions to counteract the 'anabolic resistance' of ageing. Nutr Metab (Lond). 2011;8:68.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 318]  [Cited by in F6Publishing: 310]  [Article Influence: 23.8]  [Reference Citation Analysis (0)]
121.  Morton RW, Traylor DA, Weijs PJM, Phillips SM. Defining anabolic resistance: implications for delivery of clinical care nutrition. Curr Opin Crit Care. 2018;24:124-130.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 68]  [Cited by in F6Publishing: 57]  [Article Influence: 11.4]  [Reference Citation Analysis (0)]
122.  Haran PH, Rivas DA, Fielding RA. Role and potential mechanisms of anabolic resistance in sarcopenia. J Cachexia Sarcopenia Muscle. 2012;3:157-162.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 109]  [Cited by in F6Publishing: 103]  [Article Influence: 8.6]  [Reference Citation Analysis (0)]
123.  Barclay RD, Burd NA, Tyler C, Tillin NA, Mackenzie RW. The Role of the IGF-1 Signaling Cascade in Muscle Protein Synthesis and Anabolic Resistance in Aging Skeletal Muscle. Front Nutr. 2019;6:146.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 51]  [Cited by in F6Publishing: 71]  [Article Influence: 14.2]  [Reference Citation Analysis (0)]
124.  Cuthbertson D, Smith K, Babraj J, Leese G, Waddell T, Atherton P, Wackerhage H, Taylor PM, Rennie MJ. Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle. FASEB J. 2005;19:422-424.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 801]  [Cited by in F6Publishing: 814]  [Article Influence: 40.7]  [Reference Citation Analysis (0)]
125.  Lang CH, Frost RA, Nairn AC, MacLean DA, Vary TC. TNF-alpha impairs heart and skeletal muscle protein synthesis by altering translation initiation. Am J Physiol Endocrinol Metab. 2002;282:E336-E347.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 181]  [Cited by in F6Publishing: 180]  [Article Influence: 8.2]  [Reference Citation Analysis (0)]
126.  Zhou J, Liu B, Liang C, Li Y, Song YH. Cytokine Signaling in Skeletal Muscle Wasting. Trends Endocrinol Metab. 2016;27:335-347.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 116]  [Cited by in F6Publishing: 120]  [Article Influence: 15.0]  [Reference Citation Analysis (0)]
127.  Karlsson HK, Nilsson PA, Nilsson J, Chibalin AV, Zierath JR, Blomstrand E. Branched-chain amino acids increase p70S6k phosphorylation in human skeletal muscle after resistance exercise. Am J Physiol Endocrinol Metab. 2004;287:E1-E7.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 179]  [Cited by in F6Publishing: 177]  [Article Influence: 8.9]  [Reference Citation Analysis (0)]
128.  Koopman R, Wagenmakers AJ, Manders RJ, Zorenc AH, Senden JM, Gorselink M, Keizer HA, van Loon LJ. Combined ingestion of protein and free leucine with carbohydrate increases postexercise muscle protein synthesis in vivo in male subjects. Am J Physiol Endocrinol Metab. 2005;288:E645-E653.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 191]  [Cited by in F6Publishing: 175]  [Article Influence: 9.2]  [Reference Citation Analysis (0)]
129.  Burd NA, Yang Y, Moore DR, Tang JE, Tarnopolsky MA, Phillips SM. Greater stimulation of myofibrillar protein synthesis with ingestion of whey protein isolate v. micellar casein at rest and after resistance exercise in elderly men. Br J Nutr. 2012;108:958-962.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 172]  [Cited by in F6Publishing: 182]  [Article Influence: 15.2]  [Reference Citation Analysis (0)]
130.  Yang Y, Breen L, Burd NA, Hector AJ, Churchward-Venne TA, Josse AR, Tarnopolsky MA, Phillips SM. Resistance exercise enhances myofibrillar protein synthesis with graded intakes of whey protein in older men. Br J Nutr. 2012;108:1780-1788.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 311]  [Cited by in F6Publishing: 326]  [Article Influence: 27.2]  [Reference Citation Analysis (0)]
131.  Shad BJ, Thompson JL, Breen L. Does the muscle protein synthetic response to exercise and amino acid-based nutrition diminish with advancing age? Am J Physiol Endocrinol Metab. 2016;311:E803-E817.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 72]  [Cited by in F6Publishing: 78]  [Article Influence: 9.8]  [Reference Citation Analysis (0)]
132.  Luo D, Lin Z, Li S, Liu SJ. Effect of nutritional supplement combined with exercise intervention on sarcopenia in the elderly: A meta-analysis. Int J Nurs Sci. 2017;4:389-401.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 15]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
133.  Cermak NM, Res PT, de Groot LC, Saris WH, van Loon LJ. Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: a meta-analysis. Am J Clin Nutr. 2012;96:1454-1464.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 539]  [Cited by in F6Publishing: 523]  [Article Influence: 43.6]  [Reference Citation Analysis (0)]
134.  Chen BP, Awasthi R, Sweet SN, Minnella EM, Bergdahl A, Santa Mina D, Carli F, Scheede-Bergdahl C. Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Support Care Cancer. 2017;25:33-40.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 86]  [Cited by in F6Publishing: 60]  [Article Influence: 7.5]  [Reference Citation Analysis (0)]
135.  McDonald SR, Heflin MT, Whitson HE, Dalton TO, Lidsky ME, Liu P, Poer CM, Sloane R, Thacker JK, White HK, Yanamadala M, Lagoo-Deenadayalan SA. Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative. JAMA Surg. 2018;153:454-462.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 89]  [Cited by in F6Publishing: 105]  [Article Influence: 21.0]  [Reference Citation Analysis (0)]
136.  Janssen TL, Steyerberg EW, Langenberg JCM, de Lepper CCHAVH, Wielders D, Seerden TCJ, de Lange DC, Wijsman JH, Ho GH, Gobardhan PD, van Alphen R, van der Laan L. Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study. PLoS One. 2019;14:e0218152.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 37]  [Cited by in F6Publishing: 45]  [Article Influence: 9.0]  [Reference Citation Analysis (0)]
137.  Barberan-Garcia A, Ubré M, Roca J, Lacy AM, Burgos F, Risco R, Momblán D, Balust J, Blanco I, Martínez-Pallí G. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg. 2018;267:50-56.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 382]  [Cited by in F6Publishing: 401]  [Article Influence: 66.8]  [Reference Citation Analysis (0)]
138.  Souwer ETD, Bastiaannet E, de Bruijn S, Breugom AJ, van den Bos F, Portielje JEA, Dekker JWT. Comprehensive multidisciplinary care program for elderly colorectal cancer patients: "From prehabilitation to independence". Eur J Surg Oncol. 2018;44:1894-1900.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 26]  [Cited by in F6Publishing: 26]  [Article Influence: 4.3]  [Reference Citation Analysis (0)]
139.  Looijaard SMLM, Slee-Valentijn MS, Otten RHJ, Maier AB. Physical and Nutritional Prehabilitation in Older Patients With Colorectal Carcinoma: A Systematic Review. J Geriatr Phys Ther. 2018;41:236-244.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 31]  [Cited by in F6Publishing: 33]  [Article Influence: 5.5]  [Reference Citation Analysis (0)]
140.  Bruns ER, van den Heuvel B, Buskens CJ, van Duijvendijk P, Festen S, Wassenaar EB, van der Zaag ES, Bemelman WA, van Munster BC. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis. 2016;18:O267-O277.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 122]  [Cited by in F6Publishing: 125]  [Article Influence: 15.6]  [Reference Citation Analysis (0)]
141.  Dronkers JJ, Lamberts H, Reutelingsperger IM, Naber RH, Dronkers-Landman CM, Veldman A, van Meeteren NL. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study. Clin Rehabil. 2010;24:614-622.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 183]  [Cited by in F6Publishing: 187]  [Article Influence: 13.4]  [Reference Citation Analysis (0)]
142.  Mazzola M, Bertoglio C, Boniardi M, Magistro C, De Martini P, Carnevali P, Morini L, Ferrari G. Frailty in major oncologic surgery of upper gastrointestinal tract: How to improve postoperative outcomes. Eur J Surg Oncol. 2017;43:1566-1571.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 44]  [Article Influence: 6.3]  [Reference Citation Analysis (0)]
143.  Chia CL, Mantoo SK, Tan KY. 'Start to finish trans-institutional transdisciplinary care': a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis. 2016;18:O43-O50.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 62]  [Cited by in F6Publishing: 62]  [Article Influence: 7.8]  [Reference Citation Analysis (0)]
144.  Milder DA, Pillinger NL, Kam PCA. The role of prehabilitation in frail surgical patients: A systematic review. Acta Anaesthesiol Scand. 2018;62:1356-1366.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 51]  [Cited by in F6Publishing: 63]  [Article Influence: 10.5]  [Reference Citation Analysis (0)]
145.  Hoogeboom TJ, Dronkers JJ, van den Ende CH, Oosting E, van Meeteren NL. Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: a randomized pilot trial. Clin Rehabil. 2010;24:901-910.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 75]  [Cited by in F6Publishing: 81]  [Article Influence: 5.8]  [Reference Citation Analysis (0)]
146.  Oosting E, Jans MP, Dronkers JJ, Naber RH, Dronkers-Landman CM, Appelman-de Vries SM, van Meeteren NL. Preoperative home-based physical therapy vs usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Arch Phys Med Rehabil. 2012;93:610-616.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 70]  [Cited by in F6Publishing: 59]  [Article Influence: 4.9]  [Reference Citation Analysis (0)]
147.  Waite I, Deshpande R, Baghai M, Massey T, Wendler O, Greenwood S. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg. 2017;12:91.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 100]  [Cited by in F6Publishing: 113]  [Article Influence: 16.1]  [Reference Citation Analysis (0)]
148.  Ommundsen N, Wyller TB, Nesbakken A, Bakka AO, Jordhøy MS, Skovlund E, Rostoft S. Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial. Colorectal Dis. 2018;20:16-25.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 72]  [Cited by in F6Publishing: 80]  [Article Influence: 13.3]  [Reference Citation Analysis (0)]
149.  Yamamoto K, Nagatsuma Y, Fukuda Y, Hirao M, Nishikawa K, Miyamoto A, Ikeda M, Nakamori S, Sekimoto M, Fujitani K, Tsujinaka T. Effectiveness of a preoperative exercise and nutritional support program for elderly sarcopenic patients with gastric cancer. Gastric Cancer. 2017;20:913-918.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 136]  [Article Influence: 19.4]  [Reference Citation Analysis (0)]
150.  Ritch CR, Cookson MS, Clark PE, Chang SS, Fakhoury K, Ralls V, Thu MH, Penson DF, Smith JA Jr, Silver HJ. Perioperative Oral Nutrition Supplementation Reduces Prevalence of Sarcopenia following Radical Cystectomy: Results of a Prospective Randomized Controlled Trial. J Urol. 2019;201:470-477.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 28]  [Cited by in F6Publishing: 26]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
151.  Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14:392-397.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2058]  [Cited by in F6Publishing: 2377]  [Article Influence: 216.1]  [Reference Citation Analysis (0)]
152.  Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M;  European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412-423.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6987]  [Cited by in F6Publishing: 7566]  [Article Influence: 540.4]  [Reference Citation Analysis (0)]
153.  Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21:300-307.e2.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1283]  [Cited by in F6Publishing: 1384]  [Article Influence: 346.0]  [Reference Citation Analysis (0)]
154.  Du Y, Karvellas CJ, Baracos V, Williams DC, Khadaroo RG;  Acute Care and Emergency Surgery (ACES) Group. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery. 2014;156:521-527.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 114]  [Cited by in F6Publishing: 121]  [Article Influence: 12.1]  [Reference Citation Analysis (0)]
155.  Francomacaro LM, Walker C, Jaap K, Dove J, Hunsinger M, Widom K, Torres D, Shabahang M, Blansfield J, Wild J. Sarcopenia predicts poor outcomes in urgent exploratory laparotomy. Am J Surg. 2018;216:1107-1113.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 12]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
156.  Imamura H, Haraguchi M, Minami S, Isagawa Y, Morita M, Hirabaru M, Kawahara D, Tokai H, Noda K, Inoue K, Eguchi S. The Impact of Low Muscle Mass in Patients Undergoing Emergency Surgery for Colonic Perforation - A Single-center Experience. In Vivo. 2019;33:523-528.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
157.  Tamura T, Sakurai K, Nambara M, Miki Y, Toyokawa T, Kubo N, Tanaka H, Muguruma K, Yashiro M, Ohira M. Adverse Effects of Preoperative Sarcopenia on Postoperative Complications of Patients With Gastric Cancer. Anticancer Res. 2019;39:987-992.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 31]  [Cited by in F6Publishing: 34]  [Article Influence: 6.8]  [Reference Citation Analysis (0)]
158.  Durrand J, Singh SJ, Danjoux G. Prehabilitation. Clin Med (Lond). 2019;19:458-464.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 56]  [Cited by in F6Publishing: 81]  [Article Influence: 20.3]  [Reference Citation Analysis (0)]
159.  Whittle J, Wischmeyer PE, Grocott MPW, Miller TE. Surgical Prehabilitation: Nutrition and Exercise. Anesthesiol Clin. 2018;36:567-580.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 33]  [Article Influence: 5.5]  [Reference Citation Analysis (0)]
160.  Baimas-George M, Watson M, Elhage S, Parala-Metz A, Vrochides D, Davis BR. Prehabilitation in Frail Surgical Patients: A Systematic Review. World J Surg. 2020;44:3668-3678.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 12]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
161.  Gani F, Buettner S, Margonis GA, Sasaki K, Wagner D, Kim Y, Hundt J, Kamel IR, Pawlik TM. Sarcopenia predicts costs among patients undergoing major abdominal operations. Surgery. 2016;160:1162-1171.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 47]  [Cited by in F6Publishing: 52]  [Article Influence: 6.5]  [Reference Citation Analysis (0)]
162.  Kirk PS, Friedman JF, Cron DC, Terjimanian MN, Wang SC, Campbell DA, Englesbe MJ, Werner NL. One-year postoperative resource utilization in sarcopenic patients. J Surg Res. 2015;199:51-55.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 25]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
163.  Curcio F, Ferro G, Basile C, Liguori I, Parrella P, Pirozzi F, Della-Morte D, Gargiulo G, Testa G, Tocchetti CG, Bonaduce D, Abete P. Biomarkers in sarcopenia: A multifactorial approach. Exp Gerontol. 2016;85:1-8.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 86]  [Cited by in F6Publishing: 74]  [Article Influence: 9.3]  [Reference Citation Analysis (0)]
164.  Albano D, Messina C, Vitale J, Sconfienza LM. Imaging of sarcopenia: old evidence and new insights. Eur Radiol. 2020;30:2199-2208.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 97]  [Cited by in F6Publishing: 160]  [Article Influence: 32.0]  [Reference Citation Analysis (0)]
165.  Calvani R, Marini F, Cesari M, Tosato M, Picca A, Anker SD, von Haehling S, Miller RR, Bernabei R, Landi F, Marzetti E;  SPRINTT Consortium. Biomarkers for physical frailty and sarcopenia. Aging Clin Exp Res. 2017;29:29-34.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 45]  [Cited by in F6Publishing: 37]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
166.  Marcell TJ. Sarcopenia: causes, consequences, and preventions. J Gerontol A Biol Sci Med Sci. 2003;58:M911-M916.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 344]  [Cited by in F6Publishing: 361]  [Article Influence: 17.2]  [Reference Citation Analysis (0)]
167.  Loftus TJ, Tighe PJ, Filiberto AC, Efron PA, Brakenridge SC, Mohr AM, Rashidi P, Upchurch GR Jr, Bihorac A. Artificial Intelligence and Surgical Decision-making. JAMA Surg. 2020;155:148-158.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 96]  [Cited by in F6Publishing: 145]  [Article Influence: 36.3]  [Reference Citation Analysis (0)]
168.  Chen J, Remulla D, Nguyen JH, Aastha D, Liu Y, Dasgupta P, Hung AJ. Current status of artificial intelligence applications in urology and their potential to influence clinical practice. BJU Int. 2019;124:567-577.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 63]  [Cited by in F6Publishing: 65]  [Article Influence: 13.0]  [Reference Citation Analysis (0)]
169.  Bihorac A, Ozrazgat-Baslanti T, Ebadi A, Motaei A, Madkour M, Pardalos PM, Lipori G, Hogan WR, Efron PA, Moore F, Moldawer LL, Wang DZ, Hobson CE, Rashidi P, Li X, Momcilovic P. MySurgeryRisk: Development and Validation of a Machine-learning Risk Algorithm for Major Complications and Death After Surgery. Ann Surg. 2019;269:652-662.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 106]  [Cited by in F6Publishing: 149]  [Article Influence: 37.3]  [Reference Citation Analysis (0)]
170.  Rimmer L, Howard C, Picca L, Bashir M. The automaton as a surgeon: the future of artificial intelligence in emergency and general surgery. Eur J Trauma Emerg Surg. 2021;47:757-762.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 5]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
171.  Maeda Y, Kudo SE, Mori Y, Misawa M, Ogata N, Sasanuma S, Wakamura K, Oda M, Mori K, Ohtsuka K. Fully automated diagnostic system with artificial intelligence using endocytoscopy to identify the presence of histologic inflammation associated with ulcerative colitis (with video). Gastrointest Endosc. 2019;89:408-415.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 124]  [Cited by in F6Publishing: 122]  [Article Influence: 24.4]  [Reference Citation Analysis (0)]
172.  Bi WL, Hosny A, Schabath MB, Giger ML, Birkbak NJ, Mehrtash A, Allison T, Arnaout O, Abbosh C, Dunn IF, Mak RH, Tamimi RM, Tempany CM, Swanton C, Hoffmann U, Schwartz LH, Gillies RJ, Huang RY, Aerts HJWL. Artificial intelligence in cancer imaging: Clinical challenges and applications. CA Cancer J Clin. 2019;69:127-157.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 848]  [Cited by in F6Publishing: 549]  [Article Influence: 109.8]  [Reference Citation Analysis (2)]
173.  Pew Research Center  Mobile Fact Sheet. 2019 Jun 12. [cited 22 February 2021]. [Internet]. Available from: https://www.pewresearch.org/internet/fact-sheet/mobile/.  [PubMed]  [DOI]  [Cited in This Article: ]
174.  The Manifest  56% of People Own at Least One Wearable, as Google Competes for Market Share. 2019 Nov 14. [cited 22 February 2021]. [Internet]. Available from: https://www.prnewswire.com/news-releases/56-of-people-own-at-least-one-wearable-as-google-competes-for-market-share-300958174.html.  [PubMed]  [DOI]  [Cited in This Article: ]