Abstract
The number of surgical procedures performed in older persons is increasing exponentially. Morbidity and mortality increase with age, rising sharply after the age of 75. After major abdominal surgery, up to 20% of older patients have persistent disabilities in functional status, and a sizable minority never fully recover. Traditionally, efforts to support recovery begin in the postoperative period (“rehabilitation”), but deconditioning related to the metabolic stress of surgery and hospitalization may have already initiated a downward spiral during which the patient may become increasingly inactive, further contributing to complications and disability. Preoperative physical fitness, physical activity, and nutritional status are predictors of surgical complications and prolonged disability, but may be modifiable. As such, the preoperative period may represent an opportunity to intervene to optimize physiological age (functional capacity) in anticipation of the upcoming stress of surgery, potentially reducing complications and improving recovery. This strategy has been termed “prehabilitation”. This chapter will focus on the potential role of prehabilitation to improve functional status in older patients preoperatively, thereby contributing to improved outcomes postoperatively. It will begin with a review of preoperative functional assessment, then summarize the current literature on prehabilitation, focused on the frail and older patient, including recommendations about the duration and intensity of prehabilitation programs in this population.
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Droeser, R.A., Carli, F., Feldman, L.S. (2018). Function and Prehabilitation. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20317-1_9-1
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DOI: https://doi.org/10.1007/978-3-319-20317-1_9-1
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Publisher Name: Springer, Cham
Print ISBN: 978-3-319-20317-1
Online ISBN: 978-3-319-20317-1
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