Optimizing a frail elderly patient for radical cystectomy with a prehabilitation program

Area of Science:

• Geriatric Medicine
• Oncology
• Surgical Recovery

Background:

• Frail elderly patients undergoing major surgery face significant postoperative risks.
• Radical cystectomy for urothelial carcinoma requires intensive recovery protocols.
• Prehabilitation programs aim to optimize patient condition before surgery.

Purpose of the Study:

• To report the positive impact of a multimodal prehabilitation program on the postoperative recovery of a frail patient.
• To evaluate the effectiveness of prehabilitation in improving functional status and quality of life in an elderly patient undergoing radical cystectomy.

Main Methods:

• An 85-year-old frail male patient with urothelial carcinoma was enrolled in a 4-week multimodal prehabilitation program.
• The program incorporated aerobic and resistance exercises, nutritional counseling with whey protein, and relaxation techniques.
• Outcome measures included the 6-minute walking test (6MWT), SF-36, physical activity, and Hospital Anxiety and Depression Scale (HADS).

Main Results:

• The patient demonstrated progressive improvement in functional capacity and quality of life before surgery, which continued postoperatively.
• Despite comorbidities, the surgery and immediate postoperative period were uneventful.
• The patient was discharged on postoperative day 7 and continued the program at home for 8 weeks.

Conclusions:

• Multimodal prehabilitation can significantly enhance postoperative recovery in frail elderly patients undergoing radical cystectomy.
• Prehabilitation programs focusing on exercise, nutrition, and psychological support are beneficial for optimizing surgical outcomes in vulnerable populations.
• This case underscores the importance of tailored prehabilitation strategies for improving patient resilience and recovery trajectories.