• Victor Contreras, María F Elgueta, Detlef Balde, Paula Astaburuaga, Marcela Carrasco, Juan C Pedemonte, María N Nicoletti, Rene Medina Diaz, Sebastián Franco, Raul Agurto, Catherin Vivanco, Constanza Figueroa, Mirelly Alamos, Valeria Cuzmar Benítez, Benjamin Vargas, Benjamin Barraza, Claudio Rematal, and Luis I Cortinez.
• Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
• Minerva Anestesiol. 2024 Dec 1; 90 (12): 109811071098-1107.

BackgroundFrail elderly patients have a higher risk of postoperative morbidity and mortality. Prehabilitation is a potential intervention for optimizing postoperative outcomes in frail patients. We studied the impact of a prehabilitation program on length of stay (LOS) in frail elderly patients undergoing elective surgery.MethodsAn RCT study was conducted. Frail patients scheduled for elective surgery were randomized to receive either pre-surgical conditioning protocol (PCP) or standard preoperative care. PCP included nursing, anesthetic, and geriatric assessment, nutritional intervention, and physical training for 4-weeks preoperatively. A nurse followed both groups until discharge criteria were met. The primary outcome was postoperative LOS. Secondary outcomes were nutritional status, preoperative frailty status (frailty phenotype-FP) after PCP, and postoperative complications up to three months categorized according to the Clavien-Dindo Classification. Means and medians between the control and intervention groups were compared, with statistical significance set at α=5%.ResultsThirty-four patients were to intervention and Thirty-seven to the control group. In the intervention group, adherence to prehabilitation was 90%. The median LOS after surgery was three days in both groups, without finding statistically significant differences between groups (P=0.754), although there was a trend towards lower LOS in the urologic surgery subgroup. We found a significant reduction in frailty status after PCP (FPpre=2.4±0.5 and FPpost=1.7±0.5, P<0.001). Nutritional status significantly improved in frail patients after prehabilitation (MNAbasal=9.0±2.5 and MNApost=10.6±2.6), P=0.028. The intervention group had less severe postoperative complications, which were not statistically significant.ConclusionsThe PCP conducted both in-person and online, for older frail patients undergoing elective colorectal and urological surgery was not associated with shorter LOS. However, frailty status significantly improved after completing PCP.

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