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Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial.
Ann Surg 2018; 267(1):50-56AnnS

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.

Authors+Show Affiliations

Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES.Anesthesiology Department, Hospital Clínic de Barcelona.Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES.Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBEREHD.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.Anesthesiology Department, Hospital Clínic de Barcelona.Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES.Anesthesiology Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28489682

Citation

Barberan-Garcia, Anael, et al. "Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: a Randomized Blinded Controlled Trial." Annals of Surgery, vol. 267, no. 1, 2018, pp. 50-56.
Barberan-Garcia A, Ubré M, Roca J, et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg. 2018;267(1):50-56.
Barberan-Garcia, A., Ubré, M., Roca, J., Lacy, A. M., Burgos, F., Risco, R., ... Martínez-Pallí, G. (2018). Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Annals of Surgery, 267(1), pp. 50-56. doi:10.1097/SLA.0000000000002293.
Barberan-Garcia A, et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: a Randomized Blinded Controlled Trial. Ann Surg. 2018;267(1):50-56. PubMed PMID: 28489682.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. AU - Barberan-Garcia,Anael, AU - Ubré,Marta, AU - Roca,Josep, AU - Lacy,Antonio M, AU - Burgos,Felip, AU - Risco,Raquel, AU - Momblán,Dulce, AU - Balust,Jaume, AU - Blanco,Isabel, AU - Martínez-Pallí,Graciela, PY - 2017/5/11/pubmed PY - 2017/12/27/medline PY - 2017/5/11/entrez SP - 50 EP - 56 JF - Annals of surgery JO - Ann. Surg. VL - 267 IS - 1 N2 - 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. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/28489682/Personalised_Prehabilitation_in_High_risk_Patients_Undergoing_Elective_Major_Abdominal_Surgery:_A_Randomized_Blinded_Controlled_Trial_ L2 - http://Insights.ovid.com/pubmed?pmid=28489682 DB - PRIME DP - Unbound Medicine ER -