Feasibility of a prehabilitation program before major abdominal surgery: a pilot prospective study
David Martín, Cyril Besson, Basile Pache, Anna Michel, Sandrine Geinoz, Vincent Gremeaux-Bader, Anna Larcinese, Charles Benaïm, Bengt Kayser, Nicolas Demartines, Martin Hübner
Abstract
Objective To assess the feasibility of a prehabilitation program and its effects on physical performance and outcomes after major abdominal surgery. Methods In this prospective pilot study, patients underwent prehabilitation involving three training sessions per week for 3 weeks preoperatively. The feasibility of delivering the intervention was assessed based on recruitment and adherence to the program. Its impacts on fitness (oxygen uptake (VO 2 )) and physical performance (Timed Up and Go Test, 6-Minute Walk Test) were evaluated. Results From May 2017 to January 2020, 980 patients were identified and 44 (4.5%) were invited to participate. The main obstacles to patient recruitment were insufficient time (<3 weeks) prior to scheduled surgery (n = 276, 28%) and screening failure (n = 312, 32%). Of the 44 patients, 24 (55%) declined to participate, and 20 (23%) were included. Of these, six (30%) were not adherent to the program. Among the remaining 14 patients, VO 2 at ventilatory threshold significantly increased from 9.7 to 10.9 mL/min/kg. No significant difference in physical performance was observed before and after prehabilitation. Conclusion Although prehabilitation seemed to have positive effects on exercise capacity, logistic and patient-related difficulties were encountered. The program is not feasible in its current form for all-comers.