Personalised Prehabilitation & Major Abdominal Surgery

Barberan-Garcia et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery. A Randomised Blinded Controlled Trial. Ann Surg. 2018 Jan;267(1):50-56.

Background

Major abdominal surgery is associated with post operative complications especially in the high risk patients. Prehabilitation exercises are postulated to increase aerobic capacity and functional reserve and therefore reduce postoperative complications.

Aim

Whether prehabilitation exercises versus standard treatment in high risk patient group having major abdominal surgery reduces postoperative complications (primary outcome).

Study Design

  • Single centre study in Hospital Clinic de Barcelona
  • Patients were randomized
  • Collaborating anaesthetists and surgeons were blinded to patient’s allocation

Inclusion criteria

  • Elective major abdominal surgery
  • High risk as categorised by
  • Age > 70 and/or ASA III/IV
  • Duke Activity Status Index Score < 46

Exclusion Criteria

  • Unstable cardiorespiratory disease
  • Unable to do exercise training
  • Cognitive impairment impeding adherence
  • Surgical timing allowed at least 4 weeks for the prehabilitation 

144 patients enrolled into study split into each arm.

Standard Care

  • Physical activity, nutritional and smoking cessation advice
  • IV iron if indicated for anaemia
  • Nutritional intervention if high-risk for malnutrition

Intervention Group (Standard care plus on top)

  • Motivational interview to assess adherence profile.
  • Personalised daily physical activity programme
  • Supervised high intensity endurance exercise programme 1-3x per week

Results (mean 6 weeks of prehabilitation)

  • Primary Outcome- 50% reduction in number of patients with complications: 31% vs 62%, RR 0.5 (95% CI 0.3-0.8), p = 0.001

Conclusion

  • High intensity endurance exercise training is feasible and safe in elderly and/or multimorbid candidates for major abdominal surgery
  • Prehabilitation enhances some clinical outcomes in high-risk candidates for elective major abdominal surgery, which maybe be explained by the increase in aerobic capacity
  • Reduced complication rate
  • Prevents > 1 complication
  • Reduced ICU length of stay

 

Summary by Dr Pushkar Patankar

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s