Multidisciplinary Prehabilitation To Improve Frailty and Functional Capacity in High-Risk Elective Surgical Patients: A Retrospective Pilot Study

Authors

Henry Man Kin Wong
Ding Qi
Bosco Hon Ming Ma
Pik Yi Hou
Calvin Ka Woon Kwong
Anna Lee
Prehab Study Group

Publication Date

1-23-2024

Journal

Perioperative Medicine

Abstract

BACKGROUND: Frailty is associated with worse outcomes and higher healthcare costs. The long waiting time for surgery is a potential 'teachable' moment. We examined the feasibility and safety of a pilot prehabilitation programme on high-risk frail patients undergoing major elective surgery.

METHODS: A single-centre, retrospective pilot study (Dec 2020-Nov 2021) on a one-stop prehabilitation programme (structured exercise training, nutritional counselling/therapy, and psychological support) in collaboration with geriatricians and allied health professionals. At least 4 weeks before surgery, patients at high risk of frailty or malnutrition, or undergoing major hepatectomy, esophagectomy, pancreaticoduodenectomy, or radical cystectomy, were referred for prehabilitation (2-3 sessions/week). The primary outcomes were the feasibility and safety of prehabilitation. The secondary outcomes were changes in functional, emotional, and nutritional status and days alive and at home within 30 days after surgery (DAH

RESULTS: Over a 12-month period, 72 out of 111 patients (64.9%) from the Perioperative Medicine Clinic were eligible for prehabilitation, of which 54 (75%) were recruited. The mean (standard deviation) age was 71.9 (6.9) years. The adherence rate to 3 weeks of prehabilitation was high in 52 (96.3%) participants. Prehabilitation improved exercise capacity (P = 0.08), enhanced some functional mobility measures (P = 0.02), and increased nutritional energy (P = 0.04) and protein intakes (P < 0.01). However, prehabilitation-related changes in muscle strength, cognitive function, and emotional resilience were minimal. The median (interquatile range) DAH

CONCLUSIONS: This outpatient-based, one-stop multidisciplinary prehabilitation programme was feasible, safe, and improved several measures of patient's physiological reserve and functional capacity.

Keywords

Preoperative exercise, Frailty, Perioperative medicine

Comments

Clinical trial registration: NCT05668221.

Data Availability Statement

PMID: 38263053