Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomised controlled trial

Abstract

Background: Prehabilitation (PREHAB), including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surgery has been postulated as an effective preventive intervention to reduce postoperative complications. However, the existing studies provide controversial results and show a clear bias toward low-risk patients. Objective: To assess the impact of personalized PREHAB on postoperative complications in high-risk patients undergoing elective major abdominal surgery. Design: RCT. Subjects were randomized (1:1 ratio) to control (standard care) or PREHAB (standard care + PREHAB). Inclusion criteria: i) aged above 70 years; and/or, ii) American Society of Anesthesiologists score III/IV. Intervention: i) motivational interview; ii) high-intensity endurance training; and, iii) promotion of physical activity. Main study outcome: Proportion of patients suffering postoperative complications. Secondary outcomes included the endurance time (ET) during cycle-ergometer exercise. Results: We randomly assigned 71 patients to the control arm and 73 to PREHAB. After excluding 19 patients due to changes in the surgical plan, 63 controls and 62 PREHAB patients were included in the intention-to-treat analysis. The PREHAB group enhanced aerobic capacity after prehabilitation (∆ET 135 (218) %; p-value Conclusions: Personalised PREHAB increased aerobic capacity in high-risk candidates for elective major abdominal surgery which can explain the enhanced clinical outcomes.