Prehabilitation to prevent complications after cardiac surgery - A retrospective study with propensity score analysis

Abstract

Background The rising prevalence of modifiable lifestyle-related risk factors (e.g. overweight and physical inactivity) suggests the need for effective and safe preoperative interventions to improve outcomes after cardiac surgery. This retrospective study explored potential short-term postoperative benefits and unintended consequences of a multidisciplinary prehabilitation program regarding in-hospital complications. Methods Data on patients who underwent elective cardiac surgery between January 2014 and April 2017 were analyzed retrospectively. Pearson’s chi-squared tests were used to compare patients who followed prehabilitation (three times per week, at a minimum of three weeks) during the waiting period with patients who received no prehabilitation. Sensitivity analyses were performed using propensity-score matching, in which the propensity score was based on the baseline variables that affected the outcomes. Results Of 1201 patients referred for elective cardiac surgery, 880 patients met the inclusion criteria, of whom 91 followed prehabilitation (53.8% ≥ 65 years, 78.0% male, median Euroscore II 1.3, IQR, 0.9–2.7) and 789 received no prehabilitation (60.7% ≥ 65 years, 69.6% male, median Euroscore II 1.6, IQR, 1.0–2.8). The incidence of atrial fibrillation (AF) was significantly lower in the prehabilitation group compared to the unmatched and matched standard care group (resp. 14.3% vs. 23.8%, P = 0.040 and 14.3% vs. 25.3%, P = 0.030). For the other complications, no between-group differences were found. Conclusions Prehabilitation might be beneficial to prevent postoperative AF. Patients participated safely in prehabilitation and were not at higher risk for postoperative complications. However, well-powered randomized controlled trials are needed to confirm and deepen these results.

Muscle strength trajectories and their association with postoperative health-related quality of life in patients undergoing coronary artery bypass grafting surgery: a prospective cohort study

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Feasibility of preoperative and postoperative physical rehabilitation for cardiac surgery patients – a longitudinal cohort study

“…The majority of the patients reported no perceived discomfort and patients rarely reported a score of 5 or higher for perceived discomfort. A previous study suggested that patients participated safely in the preoperative part of the Heart-ROCQ-pilot program and were not at higher risk for postoperative complications, while it might even prevent postoperative atrial fibrillation [ 28 ]. Thus, despite their heart disease, our selection of patients were able to safely exercise in the Heart-ROCQ-pilot program prior to and early after cardiac surgery.…”

Prehabilitation of Cardiac Surgical Patients, Part 1: Anemia, Diabetes Mellitus, Obesity, Sleep Apnea, and Cardiac Rehabilitation

“…One retrospective study demonstrated a lower incidence of atrial fibrillation in patients undergoing cardiac rehabilitation before heart surgery, but no other differences in postoperative complications were noted. 123 Rosenfeldt et al showed no difference in length of stay or atrial fibrillation as well as no difference in quality of life with similarly aerobic training preoperatively. 124 Furthermore, much like in the medical heart failure literature, there is a significant heterogeneity of the degree of frailty amongst patients in these pre-surgical studies, making quantification of prehabilitation goals and outcomes particularly challenging.…”