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Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial
Open accessAbstract
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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“A recent study from Spain reported enhanced aerobic capacity and reduced postoperative complications with a 6-week, in-person program [39].”
From Pilot study of a telehealth perioperative physical activity intervention for older adults with cancer and their caregivers (2020) · cites this paper as [39]
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Metadata
- 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
- Venue
- Annals of Surgery
- Published
- 2018-01
- Volume
- 267
- Issue
- 1
- Pages
- 50-56
- ISSN
- 0003-4932 (ISSN-L)
- 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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