Prehabilitation of Cardiac Surgical Patients, Part 1: Anemia, Diabetes Mellitus, Obesity, Sleep Apnea, and Cardiac Rehabilitation

Abstract

The concept of “prehabilitation” consists of screening for and identification of pre-existing disorders followed by medical optimization. This is performed for many types of surgery, but may have profound impacts on outcomes particularly in cardiac surgery given the multiple comorbidities typically carried by these patients. Components of prehabilitation include direct medical intervention by preoperative specialists as well as significant care coordination and shared decision making. In this two-part review, the authors describe existing evidence to support the optimization of various preoperative problems and present a few institutional protocols utilized by our center for cardiac presurgical care. This first installment will focus on the management of anemia, obesity, sleep apnea, diabetes, and cardiac rehabilitation prior to surgery. The second will focus on frailty, malnutrition, respiratory disease, alcohol and smoking cessation, and depression.

Multimodal Prehabilitation in People Awaiting Acute Inpatient Cardiac Surgery: Study Protocol for a Pilot Feasibility Trial (PreP-ACe)

“…The term prehabilitation has been used to describe interventions to improve physical and mental health prior to surgery. This could include pre-optimisation of medical conditions (4) , exercise (5)(6)(7)(8)(9) , education (5,7) , respiratory muscle training (8)(9)(10)(11) , psychological (12,13) or nutritional (13,14) interventions.…”

Challenging Paradigms and Trusting Evidence: New Approaches to Perioperative Care

“…In a two-part review, Knight and Subramanian et al summarize the literature on "prehabilitation" in cardiac surgery. 9,10 Prehabilitation refers to preoperative or pre-hospital interventions that improve patients' health, optimize physical or cognitive function, and/or reduce perioperative risk. Prehabilitation programs are an active area of perioperative research, with promising effects on postoperative pulmonary complication rates, overall morbidity, and quality of life.…”

“…Up to a third of cardiac surgery patients also have diabetes, and hemoglobin A1c levels above 8.5% quadruple patients' mortality risk. 9 The authors emphasize the anesthesiologist's role in perioperative diabetes care to reduce this risk. Given the proliferation of new diabetes medications, for example, the authors recommend that anesthesiologists become familiar with the perioperative recommendations for their use and maintain a low threshold for consultation with diabetes experts including endocrinologists and geriatricians.…”