Impact of preoperative regular physical activity on postoperative course after open abdominal aortic aneurysm surgery

Abstract

Early ambulation after open abdominal aortic aneurysm (AAA) surgery is assumed to play a key role in preventing postoperative complications and reducing hospital length of stay. However, the factors predicting early ambulation after open AAA surgery have not yet been sufficiently investigated. Here, we investigated which preoperative and intraoperative variables are associated with start time for ambulation in patients after open AAA surgery. A total of 67 consecutive patients undergoing open AAA surgery were included in the study [male, 62 (92 %); mean age, 68 years (range, 47-82 years), mean AAA diameter, 53 mm (range, 28-80 mm)]. Preoperative physical activity was examined by means of 6-min walk distance (6MWD) and a medical interview. Patients were divided into two groups, according to when independence in walking was attained: early group <3 days (n = 36) and late group ≥3 days (n = 31), and the pre-, intra-, and postoperative recovery data were compared. There were no significant differences in patient baseline characteristics or intraoperative data between the two groups. The number of patients engaging in preoperative regular physical activity and 6MWD were significantly greater (p = 0.042 and p = 0.034, respectively) in the early group than in the late group. In addition, time to hospital discharge was significantly shorter in the early group than in the late group (p = 0.031). Binary logistic regression analysis showed that preoperative regular physical activity was the only independent factor for identifying patients in the early group (odds ratio 2.769, 95 % confidence interval 1.024-7.487, p = 0.045). These results suggest that engaging in regular physical activity is an effective predictor of early ambulation after open AAA surgery.

Effectiveness and safety of structured exercise vs. no exercise for asymptomatic aortic aneurysm: systematic review and meta-analysis

“…Good fitness levels are considered important to reduce hospital stay with no reduction in surgical mortality rates. 33 These facts still do not constitute evidence to support recommending exercise to patients with small aneurysms at surveillance, since few patients have been evaluated.…”

“…(2016) 33 Case-control study. Patients were allocated to fit or unfit groups according to physical capacity.…”

Perioperative care in open aortic vascular surgery: A consensus statement by the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery

“…95 Another cohort study found AAA patients who exercised early in preparation for surgery compared to later in recovery from surgery had a significantly shorter LOS and time to attaining independence in sitting, standing, and walking. 96 While the studies had diversity of training programs and mixed results, they favor the use of the exercise component of prehabilitation and showed safety of exercise in AAA patients with no adverse events related to aneurysm.…”

An Introduction to Surgical Prehabilitation

“…This makes comparing results and data significantly difficult, with the added challenge of investigating different outcomes. Though there are papers that suggest patients who have increased physical activity levels pre-operatively, do better post-operatively than those who do not, this cannot be attributed to specific interventions and could be related to numerous other factors within their lifestyle, in addition to their activity levels [37][38][39][40] .…”