Implementation of Prehabilitation for Major Abdominal Surgery and Head and Neck Surgery: a Simplified Seven-Day Protocol.

Purpose: The aim of this prospective trial was to assess the compliance of a prehabilitation protocol on post-operative outcome after major abdominal and head and neck surgery.

Methods: A single-arm, prospective 7-day intervention trial was approved by our local IRB for patients undergoing major abdominal and head-and-neck (H&N) surgery from 8/2018 to 3/2019. This was a 7-day intervention trial at the time of pre-admission testing to assess compliance for pulmonary, nutritional, and physical activity prior to surgery.

Results: Seventy-six patients were enrolled in this compliance with IS use that was 85%, with a median of 2200 cc (range 1500-2500cc), pre-operative nutritional drink (89.5%), and chlorhexidine gluconate use was 92%. Ambulation/step compliance was only 32 patients (44%), with median steps of 7500 (range 400-15,000). Compared with the non-prehabilitation patients, we found significant improvement in immediate post-operative mobility (OR 0.73, 95% CI 0.46-0.97, p = 0.04), and improvement in prevention of pulmonary morbidity (OR 0.82, 95% CI 0.23-1.18, p = 0.07) was observed in the prehabilitation group. No significant difference in overall infectious complications (18% vs 27%), surgical site infections (14% vs 22%), length of stay (median 6 days vs 6), or readmissions (18% vs 22%).

Conclusions: A simple 7-day prehabilitation protocol at the time of pre-admission testing is feasible with a high degree of compliance regardless of a patient's disease type, education, or socioeconomic background.