Prehabilitation Program in Elderly Patients: A Prospective Cohort Study of Patients Followed Up Postoperatively for Up to 6 Months

Abstract

The preoperative period may be an opportune period to optimize patients’ physical condition with a multimodal preoperative program. The impact of a “prehabilitation” program on elderly patients is discussed. This mono-center observational cohort study included consecutively 139 patients planned for major abdominal and thoracic surgery, with 44 in the control group (age < 65) and 95 in the elderly group (age > 65). All patients followed a “prehabilitation” program including exercise training, nutritional optimization, psychological support, and behavioral change. Seventeen patients in the control group and 45 in the elderly group completed the study at six months. The 6-minute walk test (6 MWT) increased in both groups from the initial evaluation to the last (median value of 80 m (interquartile range 51) for those under 65 years; 59 m (34) for the elderly group; p = 0.114). The 6 MWT was also similar after one month of prehabilitation for both populations. The rate of postoperative complications was similar in the two groups. Prehabilitation showed equivalence in patients over 65 years of age compared to younger patients in terms of increase in functional capabilities and of postoperative evolution. This multimodal program represents a bundle of care that can benefit a frailer population.

The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis

“…As matter of the fact, frailty screening it is not routinely performed among HBP cancer patients, however findings from our metaanalysis strongly encourage clinicians to perform CGA in this population, as it represents the only method to evaluate the complexity which characterizes elderly patients with malignancies. Furthermore, frailty evaluations may provide relevant information about multiple accumulated deficits as malnutrition, physical mobility impairment and reduced cognitive performance; furthermore, it may also exert preventive role, as pre-rehabilitation procedures and new developing strategies may be applied in selected patients [58][59][60][61][62]. The oncological outcomes of laparoscopic liver resection in elderly patients with colorectal metastasis were comparable to those observed with open resection, and a reduction in both minor and major postoperative morbidity was observed [63,64].…”

Beyond Frailty Phenotype, the role of Preoperative Electronic Frailty Assessment in Predicting Postoperative Outcomes in Older Patients Undergoing Surgery for Gastrointestinal Cancer: A Systematic Review

“…The implementation of e-frailty tools in the surgical preoperative cancer setting of older adults faces several challenges that need to be addressed to maximize their potential bene ts. With the signi cant recognition of this syndrome and its adverse impact on the postoperative outcomes of older patients with cancer, speci cally gastrointestinal, the application of these approaches in daily perioperative medicine is needed [59,60]. Electronic health data sources should routinely capture aspects involving frailty, such as cognition, function, or nutrition.…”

Surgical prehabilitation in older and frail individuals: a scoping review

“…Among the trials included in this review, presurgical unimodal or multimodal interventions were examined in patients with (1) colorectal cancer (n = 10), 13,18,[21][22][23][24]30,33,40,41 pancreatic or hepatobiliary pancreatic cancer (n = 2), 16,38 gastric cancer (n = 2), 44,48 and esophageal cancer (n = 1) 27 undergoing a laparoscopic or open surgery, (2) knee osteoarthritis awaiting a total knee arthroplasty (TKA) (n = 5) 14,19.20,32,42 or hip osteoarthritis scheduled for total hip arthroplasty (THA) (n = 3), 19,28,29 (3) degenerative lumbar spine disorder (eg, disk herniation, spinal stenosis, and spondylolisthesis) scheduled for surgery (n = 1), 35 (4) coronary or valve heart disease (n = 2) 26,45 scheduled for coronary bypass graft surgery (CABG), valve replacement through sternotomy or transcatheter aortic valve replacement, (5) prostate cancer (n = 1) 15 undergoing Holmium laser enucleation or bladder cancer (n = 1) 31 undergoing cystectomy, (6) lung cancer (n = 3) 17,25,34 undergoing resection surgery, and ( 7) diverse mostly cancer-related major surgeries (eg, abdominal or intra-thoracic) (n = 6). 36,37,39,43,46,47 Details of included studies are presented in Table 1. Representative data from cited sources were used to generate a supporting figure for the review.…”

“…Thirteen intervention trials 16,18,21,22,24,25,27,30,33,36,41,44,[46][47][48] have examined the efficacy of multimodal prehabilitation in patients with colorectal cancer (n = 6), 18,21,22,30,33,41 gastric cancer (n = 2), 44,48 pancreatic cancer (n = 1), 16 lung cancer (n = 1), 25 esophageal cancer (n = 1) 27 before resection surgery, or in cancer or non-cancer patients undergoing major elective abdominal or thoracic surgeries (n = 2). 36,46,47…”