Brief Prehabilitation Reduces Postoperative Complications in Frail Gastrectomy Patients
Overview
A supervised prehabilitation program lasting approximately two weeks significantly reduced 30-day postoperative complications in older frail patients undergoing radical gastrectomy compared to standard Enhanced Recovery After Surgery (ERAS) care. The intervention improved functional capacity, decreased minor and medical complications, and shortened hospital stays.
Background
Radical gastrectomy in older patients with frailty is associated with high rates of postoperative complications, which can impair recovery and increase healthcare utilization. Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative care but may not fully address the physiological vulnerabilities of frail patients. Prehabilitation, involving exercise, nutritional support, respiratory training, and psychosocial interventions, has been proposed to enhance patients' physiological reserves before surgery. However, evidence from randomized clinical trials evaluating its efficacy in this population has been limited.
Data Highlights
Outcome
Prehabilitation Group
Standard ERAS Group
30-day postoperative complications
17%
29%
Minor complications
11%
20%
Medical complications
8%
17%
Surgical complications
No significant difference
No significant difference
ICU admission rate
23%
33%
Median postoperative hospital stay
6 days
8 days
6-minute walk test distance increase
+24 m (304 m to 328 m)
Minimal change
Preoperative anemia prevalence
19%
33%
CRP decrease (mg/dL)
0.49 to 0.23
Not reported
Neutrophil-to-lymphocyte ratio decrease
2.64 to 1.91
Not reported
Key Findings
Prehabilitation reduced overall 30-day postoperative complications from 29% to 17% in frail older patients undergoing gastrectomy.
Significant reductions were observed in minor complications (11% vs 20%) and medical complications (8% vs 17%), with no difference in surgical complications.
Patients receiving prehabilitation had lower ICU admission rates (23% vs 33%) and shorter median postoperative hospital stays (6 vs 8 days).
Functional capacity improved preoperatively, with a mean 24-meter increase in 6-minute walk test distance in the prehabilitation group.
Biomarkers of inflammation and anemia improved prior to surgery in the prehabilitation group, including decreased C-reactive protein and neutrophil-to-lymphocyte ratio, and lower prevalence of preoperative anemia.
Among patients receiving neoadjuvant chemotherapy, prehabilitation was associated with a marked reduction in postoperative complications (16% vs 39%).
Clinical Implications
Integrating a supervised, home-based multimodal prehabilitation program lasting at least two weeks into ERAS protocols for frail older patients undergoing gastrectomy can enhance physiological reserves and reduce postoperative complications. This approach may facilitate faster recovery, reduce ICU admissions, and shorten hospital stays without increasing adverse events. Clinicians should consider prehabilitation as a valuable adjunct to standard perioperative care in this high-risk population.
Conclusion
A brief, supervised prehabilitation program effectively reduces postoperative complications and improves recovery in frail older patients undergoing radical gastrectomy. Incorporation of such multimodal prehabilitation into ERAS care may optimize surgical outcomes in this vulnerable group.
References
Sun et al., JAMA Surgery 2024 -- Brief Prehabilitation Reduced Complications Prior to Gastrectomy
