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

Abstract

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 program 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 program (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. Mean (standard deviation) age was 71.9 (6.9) years. The adherence rate to three-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 program was feasible, safe, and improved several measures of patient’s physiological reserve and functional capacity. Clinical trial registration ID: NCT05668221