Abstract
Background: an increasing number of advanced age patients are considered for cardiothoracic surgeries. Prehabilitation optimizes the patients’ functional capacity and physiological reserve. However, the effectiveness of prehabilitation on physical functioning and postoperative recovery in the scope of cardiothoracic surgery is still uncertain. Objective: to assess the effectiveness of prehabilitation on pre- and/or postoperative functional capacity and physiological reserve in aged patients that are considered for cardiothoracic surgeries. Methods: this systematic review was registered in PROSPERO (CRD42021247117). The searches were conducted in PubMed, Web of Science, Scopus, and Cochrane CENTRAL until 18 April 2021. Randomized clinical trials that compared different prehabilitation strategies with usual care on the pre- and-postoperative results in aged patients undergoing cardiothoracic surgeries were included. Methodological quality was assessed by means of the Jadad scale, and the effectiveness of the interventions according to the Consensus on Therapeutic Exercise Training. Results: nine studies with 876 participants aged from 64 to 71.5 years old were included. Risk of bias was moderate due to the absence of double-blinding. The content of the interventions (multimodal prehabilitation n = 3; based on physical exercises n = 6) and the result measures presented wide variation, which hindered comparison across the studies. In general, the trials with better therapeutic quality (n = 6) reported more significant improvements in physical functioning, cardiorespiratory capacity, and in the postoperative results in the participants under-going prehabilitation. Conclusions: prehabilitation seems to improve functional capacity and postoperative recovery in aged patients undergoing cardiothoracic surgeries. However, due to the significant heterogeneity and questionable quality of the trials, both the effectiveness of prehabilitation and the optimum content are still to be determined.
Highlights
Due to demographic aging, an ever-increasing number of advanced age patients and of high-risk patients are considered for the performance of important cardiothoracic surgeries [1,2]
The loss of functional capacity produced in these patients due to the combination of aging, frailty risk, and the underlying base pathologies exert a deep impact on physical functioning and health-related quality of life after the surgery [3,4,5]
Slow gait according to the 6-min walk test, low cardiorespiratory fitness and deficient pulmonary function are the main preoperative functional parameters associated with prolonged hospitalizations, development of postoperative complications, and increased morbidity and mortality [8,9,10]
Summary
An ever-increasing number of advanced age patients (due to strategic reasons, different professional associations establish 60-years-old as the cutoff point) and of high-risk patients are considered for the performance of important cardiothoracic surgeries [1,2]. The objective of prehabilitation is to optimize the patients’ functional capacity and physiological reserve between indication and performance of the thoracic surgery, to properly prepare them for the surgical aggression. It generally includes a physical training program or multimodal therapy [5,12]. When compared to that of usual preoperative care and conventional rehabilitation [13], it was observed that prehabilitation programs seem to reduce hospitalization time and accelerate return to the functional state prior to surgery in various surgical contexts [14,15]
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