Multidisciplinary prehabilitation to improve frailty and functional capacity in high-risk elective surgical patients: a retrospective pilot study

Abstract

Background Frailty is associated with worse outcomes and higher healthcare costs. The long waiting time for surgery is a potential ‘teachable’ moment. We examined the feasibility and safety of a pilot prehabilitation programme on high-risk frail patients undergoing major elective surgery. Methods A single-centre, retrospective pilot study (Dec 2020–Nov 2021) on a one-stop prehabilitation programme (structured exercise training, nutritional counselling/therapy, and psychological support) in collaboration with geriatricians and allied health professionals. At least 4 weeks before surgery, patients at high risk of frailty or malnutrition, or undergoing major hepatectomy, esophagectomy, pancreaticoduodenectomy, or radical cystectomy, were referred for prehabilitation (2–3 sessions/week). The primary outcomes were the feasibility and safety of prehabilitation. The secondary outcomes were changes in functional, emotional, and nutritional status and days alive and at home within 30 days after surgery (DAH30) associated with prehabilitation. Results Over a 12-month period, 72 out of 111 patients (64.9%) from the Perioperative Medicine Clinic were eligible for prehabilitation, of which 54 (75%) were recruited. The mean (standard deviation) age was 71.9 (6.9) years. The adherence rate to 3 weeks of prehabilitation was high in 52 (96.3%) participants. Prehabilitation improved exercise capacity (P = 0.08), enhanced some functional mobility measures (P = 0.02), and increased nutritional energy (P = 0.04) and protein intakes (P < 0.01). However, prehabilitation-related changes in muscle strength, cognitive function, and emotional resilience were minimal. The median (interquatile range) DAH30 was 19 (14–23) days. No adverse events were reported. Conclusions This outpatient-based, one-stop multidisciplinary prehabilitation programme was feasible, safe, and improved several measures of patient’s physiological reserve and functional capacity. Clinical trial registration NCT05668221.

Effectiveness of nursing care intervention for alleviation of anxiety, pain and functional improvement amongst patients undergoing ambulatory surgery: A systematic review and meta-analysis

“…[17][18][19][20][21][22] Studies have suggested that while immediate postoperative outcomes, such as pain and anxiety, can be effectively managed through nursing interventions, [23][24][25][26][27] the long-term recovery of functional status may require a multidisciplinary approach that extends beyond the scope of nursing care alone. 28,29 This includes physical therapy and sustained patient education, emphasizing the complexity of postoperative recovery and the multifactorial nature of functional improvement status. 30 A major strength of our study lies in its comprehensive approach, and the use of meta-analysis to synthesize data from different sources.…”