To evaluate the impact of a supervised prehabilitation program on postoperative complications in older patients with frailty undergoing radical gastrectomy.
Approach:
Key Findings:
30-day postoperative complications were reduced in the prehabilitation group (17%) compared to standard care (29%).
Minor complications occurred in 11% of the prehabilitation group vs 20% in standard care.
Medical complications were 8% in the prehabilitation group vs 17% in standard care.
Improved postoperative recovery metrics: ICU admission (23% vs 33%), shorter mechanical ventilation, and shorter hospital stays (median 6 vs 8 days).
Functional capacity improved with a mean increase of 24 m in the 6-minute walk test in the prehabilitation group.
Biomarker improvements included decreased C-reactive protein and neutrophil-to-lymphocyte ratio.
Lower preoperative anemia rates in the prehabilitation group (19% vs 33%).
Interpretation:
Integrating a supervised, home-based, multimodal prehabilitation program with ERAS care may reduce surgical stress, enhance physiological reserves, and promote recovery in frail older patients.
Limitations:
Inability to perform double-blinding.
Variability in frailty assessment tools.
Lack of survival data.
Conclusion:
The study suggests that prehabilitation can significantly reduce complications and improve recovery in frail older patients undergoing gastrectomy.
