Preoperative exercise therapy preventing postoperative complications following complex abdominal wall reconstruction: A feasibility study

Abstract

PURPOSE: The population undergoing complex abdominal wall reconstructions (CAWR) tends to have significant associated, multiple comorbidities, complicating the recovery of a reconstruction. Undergoing CAWR exposes these patients to a risk for respiratory complications, which is common after CAWR. These complications are associated with an increased surgical morbidity and mortality, prolonged length of hospital stay (LOHS), an additional cost burden, and decrease in health-related quality of life (HRQoL). Improving the physical capacity before CAWR, by preoperative exercise therapy (PexT), is likely to give a better recovery and lower complication rate. In this study, we will survey the feasibility of PexT in patients undergoing a CAWR. Outcome measures will be added to demonstrate a possible effect of PexT. MATERIALS AND METHODS: A feasibility study was performed. The intervention consisted of a 3-month lasting exercise program consisting of cardiovascular, strength, and respiratory muscle training under direct supervision of a physiotherapist. The primary outcome was feasibility, defined as the occurrence of adverse events and the possibility to perform more than 80% of the intervention. The secondary outcomes were the physical capacity, HRQoL, the amount of pulmonary complications, and the LOHS. Physical capacity was measured with a cardiopulmonary exercise test (CPET) before and after the intervention and after surgery. RESULTS: Nine males and two females were included with a median age of 59 years [95% confidence interval (CI) 51–71] and a median body mass index of 31.6 kg/m2 (95% CI 28.1–36.7). The median width of the ventral hernia was 16.0 cm (95% CI 15.0–23.0). No adverse events occurred and all patients could complete the intervention. Both physical capacity and HRQoL improved after the intervention. All patients had a successful reconstruction with fascial closure. CONCLUSION: Intensive PExT is feasible in patients waiting for a CAWR. A randomized controlled trial needs to be conducted to objectivate the effect of PExT to prevent pulmonary complications and to reduce LOHS in this population.