Multimodal prehabilitation before major abdominal surgery: A retrospective study

Prehabilitation may benefit older patients undergoing major surgeries. Currently, itsefficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitationprogramme.Methods: Patients aged 65 years and above undergoing major abdominal surgery between May 2015and December 2019 in the National University Hospital were included in our institutional programmethat incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery conceptsas 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy,nutritional advice and psychosocial support were provided as part of prehabilitation.Results: There were 335 patients in the prehabilitation cohort and 256 patients whose records werereviewed as control. No difference in postoperative length of stay (P=0.150) or major complications(P=0.690) were noted. Patients in the prehabilitation group were observed to ambulate a longerdistance and participate more actively with their physiotherapists from postoperative day 1 until 4. Inthe subgroup of patients with cancer, more patients underwent neoadjuvant therapy in the prehabilitationgroup compared to the control group (21.7% versus 12.6%, P=0.009). Prehabilitation patients weremore likely to proceed to adjuvant chemotherapy (prehabilitation 87.2% vs control 65.6%, P<0.001) if ithad been recommended.Conclusion: The current study found no differences in traditional surgical outcome measures withand without prehabilitation. An increase in patient mobility in the immediate postoperative period wasnoted with prehabilitation, as well as an association between prehabilitation and increased adherenceto postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings ofthis retrospective review.Keywords: Frailty, general surgery, geriatric surgery, perioperative care, prehabilitation