SAFETY AND EFFICACY OF SURGICAL PREHABILITATION IN CARDIOVASCULAR SURGERY PATIENTS

Abstract

BACKGROUND There are many complications that patients experience after cardiothoracic surgery, including prolonged intubation, increased length of ICU stay, infection, cardiovascular and muscular deconditioning and decreased quality of life. To reduce post-surgical complication risk, pre-surgical rehabilitation (Prehab) has developed as a potential countermeasure. Prehab may include exercise training, nutrition counseling, social support, patient and family education, smoking cessation and weight management. METHODS Thirty-nine, high risk surgical patients scheduled for major cardiovascular surgery were referred to the Prehab program by their cardiovascular surgeon to prepare them for upcoming intervention. Each patient underwent pre- and post-assessments, to include a six-minute walk test (6MWT), hand grip dynamometry (GRIP), and 30-second chair stands (30SCS). Patients attended supervised exercise sessions twice weekly for at least 2 weeks leading up to their surgical procedure. The 60-minute session included symptom-limited aerobic and resistance training, along with education on nutrition and post-surgical expectations. Dependent samples t-tests were used to determine statistical significance for all pre-post comparison measures. RESULTS Average program duration was 6.3 ± 3.3 wk, average number of sessions attended was 9.9 ± 5.7 sessions and the average number of sessions per week was 1.7 ± 0.3 sessions per week. Patients exercised for 27.1 ± 5.0 min with a mean exercise heart rate at 20.7 ± 12.4 bpm above rest. There were significant increases in 30SCS (pre = 9.5 ± 4.2 reps vs. post = 11.3 ± 4.5 reps), 6MWT (pre = 343.2 ± 117.9 m vs. post = 386.1 ± 96.9 m) and MET-min -1 (pre = 64.8 ± 27.5 MET-min -1 vs. post = 87.6 ± 7.3 MET-min -1). There were no changes in weight (pre = 87.5 ± 19.7 kg vs. post = 87.7 ± 19.3 kg), BMI (pre = 29.0 ± 6.2 kg·m 2 vs. post = 29.0 ± 6.0 kg·m 2), or GRIP (15.5 ± 6.7 kg vs. post = 17.8 ± 9.6 kg). Regarding safety, 385 exercise sessions were completed by all patients and 7 sessions were deferred by the staff for clinical reasons. In addition, of the 422.5 patient-hours of exercise, no untoward events occurred. CONCLUSION Patients awaiting cardiovascular surgery can exercise safely at a low to moderate intensity and see improvements in functional capacity and muscular strength.