Annals of Surgery 2018. 267 (1)
Barberan-Garcia A, Ubre M, Roca J et al.
Aim of Study
Does prehab ‘work’ in this high-risk group of patients? (i.e. is there a relationship between improving exercise capacity & reducing post-operative risks)
Design and Location
Single centre RCT (Barcelona)
Methodology
Consecutive 1:1 randomisation of high-risk patients for elective major abdominal surgery to control or intervention group
Control Group: Walking programme & pedometers (or home exercise programme if frail), management anaemia & malnutrition, advice on smoking cessation & reduction alcohol intake
Intervention Group: Motivational interview, daily home exercise programme, supervised high-intensity endurance programme (exercise bike 1-3 times per week), plus management anaemia & malnutrition, advice on smoking cessation & reduction alcohol intake
Inclusion criteria: Age >70 or ASA 3/4, DASI <46, 4 week + prior surgery
Exclusion criteria: unstable cardiac or resp disease, limited mobility, cognitive impairment
Primary Outcome
Number of post-operative complications
Secondary Outcomes
1. Severity of post-op complications
2. Length of stay in ICU & Hospital
3. Functional capacity/Psychological/QoL measures: Endurance Time (cycling at 80% of max capacity), 6-min Walk Test, YPAS, SF-36, HADS, CPET, Pulmonary Function, Vasopressor use
Statistics
Power calculation sample size: min 70 patients per group
Group comparisons: Chi-square or Fishers exact test (Categorical) Student or Wilcoxon (Numerical)
Results
50% reduction in post-op complications
ICU length of stay 3 v 12 days
Hospital length of stay 8 v 13 days
Endurance time 138% increase
Conclusions/Discussions
Prehabilitation associated with a 138% increase in Endurance Time & 50% reduction in post-op complications
Reduced ICU & Hospital length of stay
Stated Limitations from the Study
Single centre study
Unable to blind patients
Possibly under-recruited (which may have led to statistically significant differences in hospital length of stay & intra-operative vasopressor use)
Discussion from Journal Club Meeting (?Change of Practice)
High quality evidence for the benefits of prehabilitation in this high-risk population
Lots of anecdotal evidence around to support benefits of prehab
Results of WESFIT trial awaited to hopefully add to this evidence base
Summary by Dr A Wills. Journal Club Meeting 29 October 2020.
Image from Wikimedia Commons
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