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Impact of a multimodal prehabilitation program on postoperative cognitive dysfunction: a single-center randomized
Juan Perdomo-Linares1, Manuel López-Baamonde2, Ricard Mellado-Artigas3
1Department of Anesthesiology, Hospital Clínic de Barcelona, Universitat de Barcelona (UB), Barcelona, Spain; Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
Multimodal prehabilitation did not reduce postoperative cognitive dysfunction (POCD) after cardiac surgery. However, higher physical activity post-surgery was linked to better cognitive outcomes, suggesting further research is needed.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Postoperative cognitive dysfunction (POCD) is a common complication following cardiac surgery.
- Prehabilitation, particularly exercise-based interventions, may improve functional reserve and reduce risks of perioperative brain injury.
Purpose of the Study:
- To investigate the efficacy of a multimodal prehabilitation program in reducing POCD three months after cardiac surgery.
Main Methods:
- A substudy of a randomized controlled trial involving patients aged ≥50 undergoing elective cardiac surgery.
- Participants were randomized to either a 4-6 week multimodal prehabilitation program (exercise, nutrition, psychological support) or standard care.
- Cognitive function was assessed preoperatively and three months postoperatively using a neuropsychological battery; POCD was defined by specific performance criteria.
Main Results:
- POCD occurred in 25% of patients (28% in prehabilitation group vs. 22% in control group), with no significant difference between groups (OR 1.37, 95% CI 0.54-3.50, P=0.52).
- Preoperative cognitive impairment was a strong predictor of POCD (OR 13.28, P<0.001), while prehabilitation was not associated with reduced POCD (OR 1.09, P=0.877).
- Higher physical activity levels at three months post-surgery were associated with a lower likelihood of POCD (OR 0.97, P=0.047).
Conclusions:
- A 4-6 week multimodal prehabilitation program did not significantly reduce POCD three months after cardiac surgery.
- The study did not demonstrate cognitive protection from the prehabilitation intervention.
- The association between postoperative physical activity and cognitive function warrants further investigation.
