Prehabilitation in Frail Surgical Patients: A Systematic Review
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SCIENTIFIC REVIEW
Prehabilitation in Frail Surgical Patients: A Systematic Review Maria Baimas-George1 • Michael Watson1 • Sharbel Elhage • Armida Parala-Metz2 Dionisios Vrochides1 • Bradley R. Davis3
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Frailty is a customized marker of biological age that helps to gauge an individual’s functional physiologic reserve and ability to react to stress and is associated with increased postoperative morbidity and mortality. In order to mitigate frailty preoperatively, the concept of prehabilitation has entered the forefront which encompasses multidisciplinary interventions to improve health and lessen the incidence of postoperative decline. The purpose of this study is to investigate the impact of prehabilitation on postoperative outcomes in frail, surgical patients. Methods A comprehensive literature search was performed by two independent researchers according to PRISMA guidelines. Inclusion criteria were (1) a randomized controlled trial, case–control or observational study; (2) prehabilitation intervention; (3) frailty assessment; and (4) surgical intervention. Results There were five articles included in the review. Evaluation of these articles demonstrated prehabilitation may improve operative outcomes in frail surgical patients. There were no assessments as to whether prehabilitation was cost-effective although it was feasible. Prehabilitation programs should include elements of exercise, nutrition, and psychosocial counseling. Frailty should be assessed with a validated index in surgical patients who may undergo prehabilitation. Conclusion Prehabilitation in frail surgical patients may be the appropriate process through which providers can lessen operative risk. Currently, however, there is little evidence supporting the use of prehabilitation in this population with only five studies identified in this systematic review. More randomized controlled trials are clearly needed.
Introduction
& Bradley R. Davis [email protected] 1
Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
2
Division of Internal Medicine, Department of Hospice and Palliative Medicine, Carolinas Medical Center, Charlotte, NC, USA
3
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, USA
Patient selection is a difficult aspect of surgery which is becoming progressively complex as the average life expectancy increases, shifting population demographics toward elderly cohorts. This results in a rapidly growing rate of surgery in the elderly with almost one third undergoing a procedure in their last year of life [1]. Therefore, it is essential to have reliable preoperative health assessments to appropriately risk stratify patients for preparation of outcomes and informed consent. Frailty is one useful evaluative tool that is a customized marker of biological rather than chronological age and can
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