Effectiveness of personalised physical training intervention (prehabilitation) in high-risk patients undergoing elective major abdominal surgery: a randomised controlled trial
Background: Based on the notion that preoperative functional reserve and cardiopulmonary fitness are predictors of postoperative morbidity, prehabilitation, defined as the process of enhancing the functional capacity of the individual, appears as highly promising preventive intervention to optimise preoperatively the patient’s physical condition.Goal of Study: To evaluate the effectiveness of a personalised preoperative prehabilitation intervention on postoperative outcomes in high-risk patients undergoing major abdominal surgery. Methods: Randomised double-blind controlled trial. 144 high-risk patients (>70 yrs-old and/or ASA III/IV) planned for elective major abdominal surgery were randomised to prehabilitation program or standard preoperative care. The intervention encompassed three steps: i) motivational interview; ii) personalized program to promote physical activity; and, iii) supervised endurance training program. The main outcome of study was the proportion of patients suffering from postoperative complications. Secondary outcome variables were: i) hospital and intensive care unit (ICU) days of stay; and, ii) endurance time measured by a cycling constant work-rate exercise testing. Comparisons have been done using chi2 or Fisher’s exact tests for categorical variables, and Student’s or Wilcoxon tests for numerical variables. Results: 125 patients (prehabilitation group n=62 and control group n=63) (71±10 yrs-old, 75% male) were finally included in the intention-to-treat analysis. At program discharge [duration 6(2) weeks], the prehabilitation group showed an improvement of 135(218) % in the endurance time (p<0.001) meanwhile the control group remained unchanged. The intervention group showed 20% less of patients with postoperative complications compared with controls (RR 0•5, 95% CI [0•3-0•8]; p=0.001). The intervention group showed shorter in-hospital stay, although no statistical significant showed up [8(8) vs. 13(20) days (p=0.078)]. A sensitivity analysis including only those patients admitted in the ICU (n=44), showed a significant reduction of the length of ICU stay in the intervention group [3(2) vs. 12(20) days; p=0.046]. Conclusions: Prehabilitation is effective reducing morbidity rates in high-risk patients undergoing major abdominal surgery. Easier alternatives based on moderate-intensity exercise such as walking-based intervention and the role of including nutritional and psychological support should be investigated in future. research. Supported by ESA Grant

Effectiveness of personalised physical training intervention (prehabilitation) in high-risk patients undergoing elective major abdominal surgery: a randomised controlled trial