Surgical Prehabilitation in Abdominal Surgery

Surgical Prehabilitation of Patients Taken to Major Gastrointestinal Surgery.

Randomized clinical trial evaluating changes in functional capacity, postoperative complications and 30-day mortality in patients over 60 years of age undergoing major gastrointestinal surgery who participate in a multimodal prehabilitation program, compared to non-prehabilitated patients.

Introduction: A surgical procedure can have repercussions on the functionality and quality of life of patients, reducing their functional capacity by up to 40%; poor preoperative physical performance increases the risk of perioperative morbidity and mortality by 30% and prolongs functional recovery, increasing the hospital stay of the older adult. Prehabilitation is a preoperative intervention that improves the physical, psychological and nutritional condition of the patient to obtain a better postoperative recovery, mobility and functional independence.

Objective: To evaluate changes in functional capacity, postoperative complications and 30-day mortality in patients over 60 years of age undergoing major gastrointestinal surgery who participate in a multimodal prehabilitation program (exercise, nutrition and relaxation).

Methodology: Randomized clinical trial. Two study groups will be compared, an experimental group that will receive the educational intervention (multimodal prehabilitation program) and a control group that will continue with the usual management in the Hospital. The project activities will be carried out in Telehealth modality due to COVID-19 contagion containment measures.

Expected results: To encourage interprofessional work based on common goals with standardization of data and processes to improve physical condition and reduce post-surgical complications; to establish traceability of care, clinical and functional condition of the patient. It is intended to generate scientific evidence, integrate the research groups Méderi, Rehabilitation Sciences and Clinical Research.

Inclusion Criteria:

• Patients scheduled by the General Surgery, Coloproctology and Hepatobiliary Surgery services
• Cognitive ability to follow instructions,
• Understand the material delivered (basic reading comprehension - through physical or digital media)
• Perform physical exercise.
• Aptitude to exercise according to the cardiovascular risk assessment performed by the treating physician.

Exclusion Criteria:

• Patients scheduled for surgery from the emergency department
• Patients with sepsis,
• Patients with metastatic disease, without curative perspective
• Patients with dysphagia for solid foods
• Patients with incapacitating psychiatric or neurological illnesses
• Patients with documented previous immunosuppression status (corticosteroid users in the 6 weeks prior to the randomisation) and/or HIV
• Diabetic patients, with chronic renal disease, stage 4-5, with renal replacement therapy
• Patients with heart failure decompensated, or that limits the physical exercise
• Patients with dependent mobility
• Patients with history of second primary neoplasm