Multidisciplinary Prehabilitation in High-risk Elective Surgical Patients: a Pilot Retrospective Observation Study

Frailty is a multidimensional syndrome in which multiple small physiological deficits accumulate gradually, resulting in a loss of physiological reserve and adaptability, putting a patient that is exposed to stressor at a higher risk of adverse outcomes. Both pre-frailty and frailty are associated with worse outcomes and higher healthcare costs. With the potential "teachable" moment from the long surgical waiting time in Hong Kong, the effect of a prehabilitation program incorporated into clinical care pathway in high-risk frail patients undergoing elective major surgery were evaluated.

Inclusion Criteria:Procedure-specific: major hepatectomy (resection of 3 or more Couimaud's segments), pancreaticoduodenectomy, esophagectomy and radical cystectomyPatient-specific: age 50 or above, undergoing elective major procedures, together with one of the followings:American Society of Anaesthesiologists physical status score >=3Pre-frail to moderately frail patients with a Clinical Frailty Scale 3-6 at the time of assessment at prehabilitation clinic6-minute walk test distance <400 metersDuke Activity Status Index <34Malnutritional Screening Tool score >=2Exclusion Criteria:Patients with unstable angina or unstable cardiac syndrome (New York Heart Association Class IV, critical left main coronary disease, hospitalization for arrhythmias, congestive heart failure or acute coronary syndrome before assessment at prehabilitiation clinic)Patients with left ventricular outflow obstruction (severe aortic stenosis, hypertrophic cardiomyopathy)Chronic obstructive pulmonary disease GOLD stage IVAbdominal aortic aneurysm >8.0cm or suspected dissecting or leaking aortic aneurysmCognitive deficits unable to comply with study procedures, physical limitations that would prelude rehabilitation and inability to regularly attend prehabilitation sessions.