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.
Whether prehabilitation exercises versus standard treatment in high risk patient group having major abdominal surgery reduces postoperative complications (primary outcome).
- Single centre study in Hospital Clinic de Barcelona
- Patients were randomized
- Collaborating anaesthetists and surgeons were blinded to patient’s allocation
- Elective major abdominal surgery
- High risk as categorised by
- Age > 70 and/or ASA III/IV
- Duke Activity Status Index Score < 46
- 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.
- 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
- 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