Background and Goal of Study:
One of the complications of patients undergoing radical cystectomy is mutifactorial origin anemia. The hemoglobin (Hb) preoperative levels, added to the surgery itself, which has a high bleeding risk, can result in patients requiring the transfusion of packed red blood cells (PRBCs) more frequently. Therefore, an important point in establishing a prehabilitation program is prevention and treatment of perioperative anemia and enhancing the Hb levels. This, added to specific physical exercises, will aim to improve the function of oxygen transport and try to decrease the requirement for the transfusion of PRBCs.
Preoperative Anaemia Prevention and Control by a Prehabilitation Program in Radical Cystectomy
Results and Discussion:
The sample included 141 patients, 101 in the historical cohort (NoPR) and 40 in the prospective cohort (PR).
In comparing groups with Hb baseline levels, no statistical differences were found. Significant differences were found in pre-surgical hemoglobin values: PREHAB 12.9 vs NO-PREHAB 12 (p=0.0109)
Significant differences were found between the two groups according to transfusion during hospital stay: PR 0 (0-2) vs NoPR 2 (1-4) (p<0.0001).
Although no statistical differences were found according to transfusion prior to surgery (PR 0 vs NoPR 0), six of the patients of the non-prehabilitation group required transfusion of PRBCs prior to surgery for severe anemia, whereas only one patient required transfusion in the prehabilitation group [p90=1,6 vs 0; p99=6 vs 1].
Materials and Methods:
A prospective cohort of patients included in the prehabilitation program (PREHAB, january 2015 – march 2017) was compared to an historical cohort receiving no prehabilitation (NO-PREHAB, january 2012 – december 2014), both of them following enhancing recovering protocols.
The program is based on physical therapy with aerobic and resistance exercises, respiratory exercises, nutritional and iron supplementation as well as cognitive therapy. All the patients were given iron supplements unless they had an iron overload.
The discrete variables were described as frequency (percentage) and the continuous variables as a median (interquartile range), with Fisher’s test (discrete) and Wilcoxon’s (continuous). A p value <0.05 was considered statistically significant.
Conclusion(s):
This Prehabilitation program may contribute to the optimization of perioperative Hb in patients undergoing radical cystectomy. Differences in the transfusion rate between groups may be justified by several factors, including the prehabilitation program, but also the surgical approach. More studies are needed to study measures that can help to reduce the incidence of perioperative anaemia in these patients, in order to reduce transfusion requirements, thus avoiding its side effects with less use of limited resources, resulting in a decrease in associated costs.

02 / Preoperative Anaemia Prevention and Control by a Prehabilitation Programm in Radical Cystectomy.