Authors (including presenting author) :
Tse PMY (1)(6)
Affiliation :
Division of Rehabilitation
Introduction :
Perioperative medicine and Prehabilitation is an emerging new dimension of modern medicine. Perioperative risk assessment and stratification facilitate patients to receive better preoperative, intra-operative and postoperative management. To further minimise postoperative morbidity and mortality and reduce complications, especially for high-risk groups. Prehabilitation can be programmed into preoperative management by means of optimisation of functional status.
Objectives :
A retrospective review was conducted to evaluate the outcomes of prehabilitation covering an 8-year period from 2013 to Jan 2021, in order to explore the patient characteristics, risk profiles, as well as the outcomes of the program and surgeries
Methodology :
This retrospective review aimed to study a total of 76 patients (73 male and 3 female) who participated in the prehabilitation program in Tuen Mun Hospital from Jan 2013 to Jan 2021, an 8-year period. All patients received the pilot prehabilitation in the visceral rehabilitation wards of Tuen Mun Hospital Rehabilitation Centre. Over this 8-year period, there was a trend of increasing number of patients participated in prehabilitation till 2020 when the COVID pandemic started.
For patients’ basic characteristics, their mean age was 68 years old. Among all pathologies being considered for surgeries, 56 patients (74%) had malignancies, 15 patients (20%) had benign lesions, and the remaining 5 patients had lesions of uncertain nature at the time of prehabilitation. Thoracic surgeries contributed to 65% of all surgeries done after prehabilitation. Over the years, there was a progressive increase in the number of patients with non-thoracic pathologies. e.g. colorectal cancer and cancer of liver, recruited for prehabilitation.
Regarding the patient surgical risk profile, 10 patients (13%) had the estimated perioperative mortality of 5% or above by ACS NSQIP (American College of Surgeons National Surgical Quality Improvement). Medical comorbidities were very common and were present in 96% of patients, with 42% having one medical problem and 53% having 2 or more medical problems e.g. concurrent COPD or heart diseases, or poor diabetic (DM) control. Regarding the patients’ exercise risk before prehabilitation, all were classified as high risk according to AACVPR (American Association Cardiovascular and Pulmonary Rehabilitation) exercise criteria.
Result & Outcome :
Among the total of 76 patients, 14 patients did not have post-program assessment and as a result their ultimate fitness of surgeries were not known. (5 proceeded to surgeries before evaluation; 1 considered inoperable; 2 refused operation; 2 had treatment plan changed; and 4 patients considered not fit for surgeries due to other reasons.
Among the 62 patients who had both pre and post program assessment, 18 patients (29%) belonged to group A (the ‘fit’ group), i.e. they attained the fitness threshold for surgeries before prehab, and was recruited to further enhance their fitness in order to reduce post-operative complications. 44 patients (71%) belonged to group B (the ‘poor-risk’’ group), i.e. they did not attain the fitness threshold for surgeries before prehab, and were recruited to see if they could subsequently have fulfilled the surgical fitness threshold after prehab.
For group-A (‘Fit’ group), all except one (i.e. 17 patients) underwent surgeries after prehab, i.e. 94% had surgeries done.
For the 44 group-B (‘Poor-risk’ group) patients (i.e. those initially considered not fit for the surgeries, 23 (52%) attained the surgical fitness threshold (i.e. they became ‘fit’ after prehab), with 21 of these 23 patients (91%) underwent surgeries afterwards (2 patients refused operation), and survived at the final review time point at Day-30 post-operation. For the remaining 21 patients who did not attain the surgical fitness threshold despite prehab, 7 patients (33%) underwent surgeries subsequently.
