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Improving Perioperative Functional Capacity: A Case for Prehabilitation

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Geriatric Anesthesiology

Abstract

Perioperative care is a complex intervention provided by multiple clinicians in the preoperative, intraoperative, and postoperative phases, aimed toward decreasing the perioperative stress response and limiting any functional decline due to a surgery and hospitalization. Strategies to minimize this deconditioning and accelerate the return to presurgical functionality have focused on the postoperative period in the form of rehabilitation programs. However, postoperative interventions such as an exercise program may not be helpful as patients are tired, in pain, and afraid of disturbing the surgical sites. Providing elderly patients with a structured program prior to surgery has the potential to increase their reserve and allow them to tolerate the surgical stress better. Such a program has been termed prehabilitation, as it is preemptive rather than reactive. Studies done in a colorectal cancer population highlight that 4 weeks of preoperative program involving aerobic and resistance exercises, protein supplementation and nutritional counseling, and relaxation techniques is the best strategy to improve recovery after surgery. Great care must be taken in tailoring the prehabilitation program to each individual to ensure optimal results. Although most studies included patients over 60 years of age, none of the studies have addressed specifically the elderly and frail. Nonetheless, it has been observed that at 8 weeks after surgery, 80% of patients who had received prehabilitation had recovered baseline functional capacity versus 40% of patients who did not receive such an intervention. Further research is needed in the field of prehabilitation, notably on different modalities of intervention, effect on postoperative complications and outcomes, and long-term effect.

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Authors and Affiliations

  1. Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada

    Francesco Carli & Guillaume Bousquet-Dion

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  1. Francesco Carli
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  2. Guillaume Bousquet-Dion
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Correspondence to Francesco Carli .

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Editors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

    J. G. Reves

  2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Sheila Ryan Barnett

  3. Department of Anesthesia and Perioperative Medicine, Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina, USA

    Julie R. McSwain

  4. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA

    G. Alec Rooke

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Carli, F., Bousquet-Dion, G. (2018). Improving Perioperative Functional Capacity: A Case for Prehabilitation. In: Reves, J., Barnett, S., McSwain, J., Rooke, G. (eds) Geriatric Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-66878-9_6

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  • DOI: https://doi.org/10.1007/978-3-319-66878-9_6

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