COMMENTARY

Impact of Prehabilitation on Postop Complications

Albert B. Lowenfels, MD

Disclosures

May 15, 2018

Does a preoperative rehabilitation program ("prehabilitation") have a beneficial effect on patients undergoing major abdominal surgery? To investigate this question, the authors of a study published in Annals of Surgery randomly assigned 71 patients to a control group and 73 patients to a ≥ 4-week personalized intervention program, which included high-intensity endurance training using a stationary bicycle.[1]

The main outcome variable was the presence or absence of postoperative complications. In the control group, 39 patients developed a complication compared with 19 patients in the treated group (P = .001). Cardiovascular complications were significantly reduced (8 vs 1; P = .033), and paralytic ileus was less frequent in the exercise group (10 in the control group vs 0 in the exercise group; P = .001).

Viewpoint

This randomized trial provides helpful information about the benefit of preoperative conditioning on postoperative outcome in patients undergoing abdominal surgery. Assuming an unbiased patient selection procedure, there was a gratifying reduction in complications, with cardiovascular complications having the greatest reduction. The reduction in medical complications was accompanied by a trend toward a reduction in hospital length of stay and ICU use (P = .078).

One potential drawback to this program is the length of time—a minimum of 4 weeks—required to achieve maximal conditioning. This time delay eliminates any patient with an urgent problem, or a patient whose treatment cannot be delayed for a month.

Would a shorter period of exercise be effective in reducing postoperative complications? And what about the program's cost? Answering these questions will strengthen the case for a prehabilitation program. However, the evidence presented by this study justifies additional research to provide information about the overall benefit of an organized prehabilitation program.

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