Objective:

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.

Sources:

• JAMA Surgery
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