Minerva Anestesiol. 2024 Dec;90(12):1098-1107. doi: 10.23736/S0375-9393.24.18245-4.
ABSTRACT
BACKGROUND: Frail elderly patients have a higher risk of postoperative morbidity and mortality. Prehabilitation is a potential intervention for optimizing postoperative outcomes in frail patients. We studied the impact of a prehabilitation program on length of stay (LOS) in frail elderly patients undergoing elective surgery.
METHODS: An RCT study was conducted. Frail patients scheduled for elective surgery were randomized to receive either pre-surgical conditioning protocol (PCP) or standard preoperative care. PCP included nursing, anesthetic, and geriatric assessment, nutritional intervention, and physical training for 4-weeks preoperatively. A nurse followed both groups until discharge criteria were met. The primary outcome was postoperative LOS. Secondary outcomes were nutritional status, preoperative frailty status (frailty phenotype-FP) after PCP, and postoperative complications up to three months categorized according to the Clavien-Dindo Classification. Means and medians between the control and intervention groups were compared, with statistical significance set at α=5%.
RESULTS: Thirty-four patients were to intervention and Thirty-seven to the control group. In the intervention group, adherence to prehabilitation was 90%. The median LOS after surgery was three days in both groups, without finding statistically significant differences between groups (P=0.754), although there was a trend towards lower LOS in the urologic surgery subgroup. We found a significant reduction in frailty status after PCP (FP<inf>pre</inf>=2.4±0.5 and FP<inf>post</inf>=1.7±0.5, P<0.001). Nutritional status significantly improved in frail patients after prehabilitation (MNA<inf>basal</inf>=9.0±2.5 and MNA<inf>post</inf>=10.6±2.6), P=0.028. The intervention group had less severe postoperative complications, which were not statistically significant.
CONCLUSIONS: The PCP conducted both in-person and online, for older frail patients undergoing elective colorectal and urological surgery was not associated with shorter LOS. However, frailty status significantly improved after completing PCP.
PMID:39836361 | DOI:10.23736/S0375-9393.24.18245-4
