Authors (including presenting author) :
Wong FY (1), Ching HW (1), Law PY (1), Law PL (1), Tam OY (1), Leung WC (1), Chong LY (1), Lee KL (1), Wan CK (1), Chu CK (2), Chow SL (2), Lam KM (3), Lau CW (3), Cheng CP (3), Wan S (1), Kwan WS (1), Mak MY (1)
Affiliation :
(1) Department of Physiotherapy, Tuen Mun Hospital
(2) Department of Medicine and Geriatrics, Tuen Mun Hospital
(3) Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital,
New Territories West Cluster, Hospital Authority, Hong Kong
Introduction :
Prehabilitation is an emerging concept to prepare patients with reduced physiological reserve to deal with excess stress during surgery. A multimodal prehabilitation program has been established for high risk patients scheduled for cancer surgery in Tuen Mun Hospital.
Objectives :
To evaluate the effects of prehabilitation on physical function and post-operative outcomes.
Methodology :
High risk patients scheduled for curative cancer surgery were admitted for in-patient prehabilitation from July 2020 to December 2020. The multimodal prehabilitation program consisted of: (1) an individualized exercise program with aerobic, resistance and inspiratory muscle training supervised by physiotherapists (5 sessions per week, 1.5 hours per session, for 2-4 weeks); (2) nutritional optimization; and (3) psychological preparation. Baseline characteristics were collected. Physical function before and after the program was assessed [including cardiopulmonary fitness represented by peak oxygen consumption (VO2 peak), anaerobic threshold (AT) and ventilatory equivalents for carbon dioxide (VE/VCO2) in Cardiopulmonary Exercise Testing, 6-minute walk test (6MWT) and incremental shuttle walk test (ISWT); skeletal muscle strength by handgrip; and inspiratory muscle strength by maximal inspiratory pressure (MIP)]. Self-perceived health (rating 0-10) and confidence towards surgery (rating 0-10), program satisfaction (rating 0-10) and post-operative cardiopulmonary complications and mortality were also reviewed.
Result & Outcome :
A total of 9 patients [aged 71.9±3.9 years (mean±SD), 66.7% male] were recruited to the program. American Society of Anesthesiologists (ASA) scored from 2 to 4. After prehabilitation, 8 out of 9 patients completed surgery, while one patient declined surgery due to personal reason. The sites of surgery included lung (37.5%), bladder (25.0%), colorectal (12.5%), pancreas (12.5%) and uterus (12.5%). Comorbidities included chronic obstructive pulmonary disease (44.4%), diabetes (44.4%), ischemic heart disease (11.1%) and stroke (11.1%). The duration of pre-operative exercise training was 16±4 sessions. After prehabilitation, patients showed significant improvements in cardiopulmonary function [VO2 peak from 14.5±2.8 to 18.1±3.5 mL/min/kg, p=0.034; 6MWT from 313±68 to 401±52 m, p=0.005; ISWT from 216±60 to 307±113 m, p=0.033]; skeletal muscle strength (handgrip strength from 19.4±6.3 to 20.9±5.9 kg, p=0.020); and inspiratory muscle strength (MIP from 52±10 to 64±7 cmH2O, p=0.015). Patients also expressed high program satisfaction [median (IQR) 10 (9-10)] and higher ratings of self-perceived health (from 3±0 to 8±1, p< 0.001) and confidence towards surgery (from 4±1 to 9±1, p=0.001) after the program. There were no documented post-operative cardiopulmonary complications or mortality. The preliminary results supported that multimodal prehabilitation could be effective to improve physical function and post-operative outcomes in high-risk patients undergoing cancer surgery.
