ADHERENCE OF PATIENTS TO MULTIMODAL PREHABILITATION IN RADICAL CYSTECTOMY. 

Background:

Enhanced recovery after surgery (ERAS) programs implement a series of interventions to optimize medical conditions and improve functional capacity (prehabilitation) in the preoperative setting to increase recovery and reduce postoperative complications.

Objectives:
The primary objective of this study was to assess the adherence to the multimodal prehabilitation program and the influence of age as a factor (<70 vs ≥ 70 yrs). 
Secondary objective was to evaluate the correlation between a 6-minute walking test (6MWT) < 350m and complications in patients undergoing open or laparoscopic/robotic radical cystectomy (RC). 

Methods: 
This study included 47 consecutive patients enrolled in an ERAS protocol, each of whom underwent RC from December 2016 to November 2017.
A prospective evaluation of the adherence to the preoperative program was performed on these items: correction of anemia, psychological support, stomatherapy education, smoking and alcohol cessation, nutrition supplementation, stretching exercises and aerobic training (evaluated by 6MWT) .
To compare means and percentages we used Mann Whitney U test and  χ2 test respectively. Statistical analysis was performed by SPSS software.

Results:
Overall compliance to the preoperative items was 93.8%. No differences were found between patients <70yrs and ≥70yrs (91.8% and 95.3% respectively; p=0.212). 
The highest compliance was alcohol abstinence (100%), the lowest was smoking cessation (28.6%).
Adherence to psychologist and stomatherapy visits were 97.9%.
Preoperative nutritional support adherence was 91.5%. There were 16 patients with a Hb <130mg/dl,  8  of them (50%) were treated with intravenous iron.

45 patients (95.7%) did the stretching exercises and 44 (93.6%) the aerobic training at home. 3 of them (6.4%) walked a distance <350m before surgery. There was no association between the distance walked and postoperative complications (p=0.239).

Conclusions:
Our results showed a high adherence to the preoperative components of ERAS protocol regardless of age, probably due to highly committed multidisciplinary team.  
The effectiveness of aerobic training to reduce postsurgical complications in RC should be investigated in future research with a large number of patients.

11 / Adherence of Patients to Multimodal Prehabilitation in Radical Cystectomy