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Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery

A Randomized Blinded Controlled Trial

Barberan-Garcia, Anael MSc*; Ubré, Marta MD; Roca, Josep Prof. PhD*; Lacy, Antonio M. Prof. PhD; Burgos, Felip PhD*; Risco, Raquel MD; Momblán, Dulce PhD§; Balust, Jaume MD; Blanco, Isabel PhD*; Martínez-Pallí, Graciela PhD

doi: 10.1097/SLA.0000000000002293
RANDOMIZED CONTROLLED TRIALS
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Objective: The aim of this study was to assess the impact of personalized prehabilitation on postoperative complications in high-risk patients undergoing elective major abdominal surgery.

Summary Background Data: Prehabilitation, including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surgery has been postulated as an effective preventive intervention to reduce postoperative complications. However, the existing studies provide controversial results and show a clear bias toward low-risk patients.

Methods: This was a randomized blinded controlled trial. Eligible candidates accepting to participate were blindly randomized (1:1 ratio) to control (standard care) or intervention (standard care + prehabilitation) groups. Inclusion criteria were: i) age >70 years; and/or, ii) American Society of Anesthesiologists score III/IV. Prehabilitation covered 3 actions: i) motivational interview; ii) high-intensity endurance training; and promotion of physical activity. The main study outcome was the proportion of patients suffering postoperative complications. Secondary outcomes included the endurance time (ET) during cycle-ergometer exercise.

Results: We randomized 71 patients to the control arm and 73 to intervention. After excluding 19 patients because of changes in the surgical plan, 63 controls and 62 intervention patients were included in the intention-to-treat analysis. The intervention group enhanced aerobic capacity [ΔET 135 (218) %; P < 0.001), reduced the number of patients with postoperative complications by 51% (relative risk 0.5; 95% confidence interval, 0.3–0.8; P = 0.001) and the rate of complications [1.4 (1.6) and 0.5 (1.0) (P = 0.001)] as compared with controls.

Conclusion: Prehabilitation enhanced postoperative clinical outcomes in high-risk candidates for elective major abdominal surgery, which can be explained by the increased aerobic capacity.

*Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES

Anesthesiology Department, Hospital Clínic de Barcelona

Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBEREHD

§Gastrointestinal Surgery Department, Hospital Clínic de Barcelona

Anesthesiology Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona.

Reprints: Anael Barberan-Garcia, MSc; Prof Josep Roca, PhD, Hospital Clínic de Barcelona, Respiratory Clinic Institute, Villarroel 170, Barcelona, 08036, Catalonia. E-mail: anbarber@clinic.cat; jroca@clinic.cat.

Sources of support: CONNECARE H2020-689802, NEXTCARE COMRDI15-1-0016, ESA Research Support Grant 2016, FIS-PITES (PI15/00576), FIS (PI13/00425), FIS-PITES-ISA (PI12/01241), and Generalitat de Catalunya (2014SGR661).

I.B. and G.M-P. contributed equally to the achievement of this work.

The authors report no conflicts of interest.

Contributors: A.B.G. wrote the first draft of the manuscript, did the statistical analysis, and performed the intervention. A.B.G. also contributed to the study design, data collection, and interpretation and contributed to and approved the final version of the manuscript. M.U. contributed to the study design, data collection, and interpretation and contributed to and approved the final version of the manuscript. J.R. contributed to the study design and data interpretation and contributed to and approved the final version of the manuscript. A.M.L. contributed to the study design, data interpretation and contributed to and approved the final version of the manuscript. F.B. contributed to data collection and contributed to and approved the final version of the manuscript. R.R. contributed to the data collection and contributed to and approved the final version of the manuscript. D.M. contributed to the study design and contributed to and approved the final version of the manuscript. J.B. contributed to the study design, data interpretation, and contributed to and approved the final version of the manuscript. I.B. contributed to the study design, data collection, and interpretation and contributed to and approved the final version of the manuscript. G.M.P. contributed to the study design, data interpretation, and contributed to and approved the final version of the manuscript.

We Anael Barberan-Garcia and Josep Roca, the corresponding authors of this manuscript, certify that we have listed everyone who contributed significantly to the work.

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