• Ning Qi Pang, Stephanie Shengjie He, Joel Qi Xuan Foo, Natalie Hui Ying Koh, Tin Wei Yuen, Ming Na Liew, John Peter Ramya, Yijun Loy, BonneyGlenn KunnathGK, Wai Kit Cheong, Shridhar Ganpathi Iyer, Ker Kan Tan, Wan Chin Lim, and KowAlfred Wei ChiehAWC.
• Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore.
• Ann Acad Med Singap. 2021 Dec 1; 50 (12): 892-902.

IntroductionPrehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme.MethodsPatients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation.ResultsThere were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay (P=0.150) or major complications (P=0.690) were noted. Patients in the prehabilitation group were observed to ambulate a longer distance and participate more actively with their physiotherapists from postoperative day 1 until 4. In the subgroup of patients with cancer, more patients had undergone neoadjuvant therapy in the prehabilitation group compared to the control group (21.7% versus 12.6%, P=0.009). Prehabilitation patients were more likely to proceed to adjuvant chemotherapy (prehabilitation 87.2% vs control 65.6%, P<0.001) if it had been recommended.ConclusionThe current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.

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