Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery

Annals of Surger 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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