Prehabilitation vs Postoperative Rehabilitation for Frail Patients

To the Editor Interest in surgical prehabilitation programs to improve postoperative patient-related and treatment-related outcomes is growing since our 2006 JAMA publication. Despite accumulating evidence about its effectiveness to improve preoperative physical fitness, there seems to be inconclusive and opposing evidence concerning its effect on postoperative outcomes. The trial of Carli et al significantly adds to this literature by demonstrating that prehabilitation in (pre)frail patients opting for resection of colorectal cancer did not reduce postoperative complications. Although suitably focused at including less physically fit (prefrail and frail) patients undergoing colorectal cancer resection, an alternative strategy might be more appropriate to select those patients who really need prehabilitation. Because preoperative aerobic performance has consistently been reported to be independently associated with complications following elective colorectal surgery, performing a cardiopulmonary exercise test to objectively measure preoperative aerobic fitness would probably be the superior risk screening strategy. Perioperative metabolic demand is significantly increased depending on the magnitude of the surgical procedure, which needs to be met by the oxygen transport and use system. Patients undergoing major abdominal surgery with a low preoperative aerobic fitness (oxygen uptake<11 mL/kg/min at the ventilatory anaerobic threshold and/or<18 mL/kg/min at peak exercise...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research