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Function and Prehabilitation

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Principles and Practice of Geriatric Surgery

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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Author information

Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Raoul A. Droeser & Liane S. Feldman

  2. Department of Anesthesiology, McGill University, Montreal, QC, Canada

    Franco Carli

  3. Department of Surgery, McGill University, Montreal, QC, Canada

    Liane S. Feldman

Authors
  1. Raoul A. Droeser
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  2. Franco Carli
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  3. Liane S. Feldman
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Corresponding author

Correspondence to Liane S. Feldman .

Editor information

Editors and Affiliations

  1. VA Connecticut Health Care System, Yale University School of Medicine, West Haven, CT, USA

    Ronnie A. Rosenthal

  2. Weill Cornell Medicine, Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA

    Michael E. Zenilman

  3. Department of Surgery, Sinai Center for Geriatric Surgery, Sinai Hospital, Baltimore, MD, USA

    Mark R. Katlic

Section Editor information

  1. Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA

    Marcia McGory Russell

  2. Ariadne Labs, Boston, MA, USA

    Zara Cooper

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Droeser, R.A., Carli, F., Feldman, L.S. (2020). Function and Prehabilitation. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-47771-8_9

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  • DOI: https://doi.org/10.1007/978-3-319-47771-8_9

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