A supervised prehabilitation program reduced 30-day postoperative complications compared with standard Enhanced Recovery After Surgery care in older patients with frailty undergoing radical gastrectomy (17% vs 29%).
In a multicenter randomized clinical trial conducted across 15 centers in China, 368 patients aged 65 to 85 years with frailty were randomly assigned to Enhanced Recovery After Surgery (ERAS) care with or without at least 2 weeks of prehabilitation; 347 patients were included in the modified intention-to-treat analysis.
Reductions were observed primarily in minor and medical complications. Minor complications occurred in 11% of patients receiving prehabilitation vs 20% in standard care, while medical complications occurred in 8% vs 17%, respectively. Surgical complication rates did not differ between groups.
Patients in the prehabilitation group also experienced improved postoperative recovery, including lower rates of intensive care unit admission (23% vs 33%), shorter durations of mechanical ventilation, and shorter postoperative hospital stays (median, 6 vs 8 days).
Functional capacity increased prior to surgery in the prehabilitation group. The 6-minute walk test distance increased by a mean of 24 m, with walking distance improving from approximately 304 m at baseline to 328 m prior to surgery, while values in the standard care group changed minimally.
Biomarker improvements were also observed. C-reactive protein decreased from 0.49 to 0.23 mg/dL, and the neutrophil-to-lymphocyte ratio decreased from 2.64 to 1.91 prior to surgery. The proportion of patients with preoperative anemia was lower in the prehabilitation group (19% vs 33%).
In subgroup analyses, among patients who received neoadjuvant chemotherapy, postoperative complications occurred in 16% of the prehabilitation group vs 39% of the standard care group. Among patients who did not receive neoadjuvant chemotherapy, differences were observed in medical and minor complications.
The prehabilitation intervention included exercise and respiratory training, nutritional support, and psychosocial intervention, delivered over a mean duration of approximately 14 days. Compliance reached 94%, and no intervention-related adverse events were reported.
Most patients had multiple comorbidities (83%), and baseline characteristics were similar between groups. Limitations included the inability to perform double-blinding, variability in frailty assessment tools, and lack of survival data.
“[I]ntegrating a supervised, home-based, multimodal prehabilitation program lasting at least 2 weeks with [ERAS] care may minimize surgical stress, enhance physiological reserves, reduce postoperative complications, and promote surgical recovery,” wrote lead study author Yuqi Sun, MD, of the Department of General Surgery at the Affiliated Hospital of Qingdao University in China, and colleagues.
The researchers reported no conflicts of interest.
Source: JAMA Surgery