Cited by 858Enhanced Recovery After SurgeryCardiac, Anesthesia and Surgical OutcomesHemodynamic Monitoring and Therapy

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Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial

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Barberan-Garcia, Anael, Ubré, Marta, Roca, Josep, Lacy, Antonio M., Burgos, Felip, Risco, Raquel, Momblán, Dulce, Balust, Jaume, Blanco, Isabel, Martínez-Pallí, Graciela·2018·Annals of Surgery

DOI 10.1097/sla.0000000000002293

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Abstract

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.

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Additional file 3 of Barriers and facilitators to participation in exercise prehabilitation before cancer surgery for older adults with frailty: a qualitative study
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Additional file 1 of Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement
Kappenschneider, T., Maderbacher, G., Weber, M., Greimel, F., Holzapfel, D., Parik, L., Schwarz, T., Leiß, F., Knebl, M., Reinhard, J., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22603114
Additional file 2 of Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement
Kappenschneider, T., Maderbacher, G., Weber, M., Greimel, F., Holzapfel, D., Parik, L., Schwarz, T., Leiß, F., Knebl, M., Reinhard, J., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22603117
Additional file 1 of Evaluation of postoperative results after a presurgical optimisation programme
Sánchez, F. J. G., & Mudarra García, N. (2024) · Figshare · doi:10.6084/m9.figshare.26308979
Additional file 1 of A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions
van Wijk, L., van der Snee, L., Buis, C. I., Hentzen, J. E. K. R., Haveman, M. E., & Klaase, J. M. (2021) · Figshare · doi:10.6084/m9.figshare.14052510
Additional file 1 of Prehabilitation of surgical patients: a bibliometric analysis from 2005 to 2023
Ma, W., Liu, Y., Liu, J., Qiu, Y., & Zuo, Y. (2024) · Figshare · doi:10.6084/m9.figshare.25951783
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Ripollés‐Melchor, J., Espinosa, Á. V., Abad‐Motos, A., Abad-Gurumeta, A., Galán-Menéndez, P., Vaca, A. Z., Navarro-Perez, R., Ruiz-Escobar, A., Fernanz-Antón, J., Suárez-de-la-Rica, A., et al. (2026) · Revista Española de Anestesiología y Reanimación (English Edition) · doi:10.1016/j.redare.2026.501990
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Authors: Barberan-Garcia, A., Ubré, M., Roca, J., Lacy, A. M., Burgos, F., Risco, R., Momblán, D., Balust, J., Blanco, I., & Martínez-Pallí, G.
Affiliations: Hospital Clínic de Barcelona (ES)
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES)
Corresponding author: Roca, Josep
Burgos, Felip
Blanco, Isabel
ORCID: Roca, Josep
Burgos, Felip
Risco, Raquel
Balust, Jaume
Blanco, Isabel
Venue: Annals of Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2018-01
Volume: 267
Issue: 1
Pages: 50-56
ISSN: 0003-4932 (ISSN-L)
DOI: 10.1097/sla.0000000000002293
OpenAlex: W2612931787
Cited by: 858
References: 27
Citations by year: 2026: 100 · 2025: 95 · 2024: 95 · 2023: 101 · 2022: 122 · 2021: 120 · 2020: 94 · 2019: 80 · 2018: 48
FWCI: 62.77
Type: journal article
Language: en
Open access: green
zenodo.org
Licence: other-oa
Locations: Annals of Surgery (publishedVersion)
PubMed (publishedVersion)
Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Keywords: prehabilitation, high-risk surgical patients, postoperative complications, endurance training, cardiorespiratory fitness, motivational interviewing, physical activity promotion, older adults
MeSH terms: Abdomen, Aged, Exercise Therapy, Female, Humans, Male, Postoperative Complications, Preoperative Care, Retrospective Studies, Risk Factors, Digestive System Surgical Procedures, Treatment Outcome, Elective Surgical Procedures, Precision Medicine

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Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial

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