Optimization of surgical outcomes with prehabilitation

Abstract

The concept of preparing surgical candidates with various modalities designed to increase physical, physiological, metabolic, and psychosocial reserves is known as prehabilitation. Prehabilitation has garnered significant attention in recent years as evidence grows describing benefits to clinical and quality of life outcomes. Recent research examining hospital length of stay and readmission rates provides promising findings with respect to the value of prehabilitation in economic and sustainable healthcare models. The role of prehabilitation across the surgical experience exploits common surgical wait-times and the teachable moment that many patients experience upon the identification of a surgical requirement to improve the pre-, peri-, and postoperative experience. Prehabilitation incorporates numerous systemic and regional approaches to conditioning the surgical candidate. These include exercise, nutrition, education, and/or psychosocial approaches that are intended to improve preoperative fitness and preparedness. Importantly, this also promotes and facilitates health behaviour changes not only preoperatively but during the postoperative period and over the long-term. In this paper, we briefly review the historical and current perspectives on prehabilitation and comment on opportunities for greater clinical and empirical understanding in this field.

Making the elderly fit for surgery

“…Preoperative assessment should identify those at high and low risk of postoperative complications. Older patients in general exhibit a gradual decline in physiological function and reserves in multiple organ systems. Especially frail, sedentary, elderly patients with co‐morbidities, and receiving (co)‐interventions such as neoadjuvant chemo(radio) therapy for cancer, may experience a steep deconditioning in the preoperative phase.…”

Reversibility of Frailty After Bridge-to-Transplant Ventricular Assist Device Implantation or Heart Transplantation

“…3,4 We believe that future studies should focus on identification of measures to distinguish reversible from irreversible frailty and on the role of prehabilitation to see if frailty can be reversed at least in part before BTT-VAD or HTx. 17-19 …”

Multidisciplinary Inpatient Rehabilitation Following Heart and/or Lung Transplantation—Examining Cohort Characteristics and Clinical Outcomes

“…In the future, it would be informative to compare outcomes for patients who received rehabilitation via other pathways, including in‐reach rehabilitation teams in the acute hospital and/or as outpatients via a day rehabilitation model. It would also be prudent to examine the effect of “prehabilitation” delivered prior to surgery, to reverse preoperative frailty where possible and improve postsurgical outcomes . To build on the work of Tang and colleagues, further research is needed to identify predictors of rehabilitation needed in heart‐lung transplant recipients, and to explore the optimal timing, doses, and durations of different rehabilitation models following cardiopulmonary transplantation.…”