Preoperative Rehabilitation Is Feasible in the Weeks Prior to Surgery and Significantly Improves Functional...

Area of Science:

• Gerontology
• Surgical Outcomes
• Rehabilitation Medicine

Background:

• Frailty is a state of increased vulnerability in patients, leading to higher risks of adverse surgical outcomes.
• Postoperative rehabilitation strategies are known to improve patient outcomes by enhancing strength.
• Identifying effective interventions for frail patients undergoing surgery is crucial for improving recovery.

Purpose of the Study:

• To assess the feasibility and impact of a novel, comprehensive prehabilitation program for frail individuals scheduled for major surgery.
• To evaluate the effectiveness of a multi-faceted intervention designed to improve functional capacity before surgical procedures.

Main Methods:

• A single-arm clinical trial was conducted at a Veterans Affairs hospital.
• Participants included frail patients (Risk Analysis Index ≥30) preparing for major abdominal, urological, thoracic, or cardiac surgery.
• The intervention involved supervised and home-based exercise (strength, coordination, respiratory muscle training, aerobic conditioning) and nutritional support, tailored to a 4-6 week pre-surgery period.

Main Results:

• 36 out of 43 patients (84%) completed the prehabilitation program, with 32 (74%) followed up to 90 days post-surgery.
• Significant improvements were observed in functional measures, including decreased timed-up-and-go time, increased gait speed, and enhanced six-minute walk test distance.
• Respiratory muscle strength also significantly increased, indicated by improvements in maximum and mean inspiratory and expiratory pressures.

Conclusions:

• Prehabilitation is a feasible and effective intervention for frail patients prior to major surgery.
• The program demonstrated clinically meaningful improvements in functional performance, suggesting a positive impact on postoperative recovery.
• These findings provide a strong rationale for conducting larger trials to confirm the benefits of prehabilitation on surgical outcomes.