Prehabilitation program in elderly patients: a prospective cohort study

The preoperative period may be an opportune period to optimize the
patients’ physical condition with a multimodal preoperative program. The
impact of a "prehabilitation" program in elderly patients is
discussed. This mono-centre observational cohort study included
consecutively 139 patients planned for major abdominal and thoracic
surgery: 44 in the control group (age<65) and 95 in the elderly
group (age> 65). All patients followed a
"prehabilitation" program including exercise training,
nutritional optimization, psychological support, and behavior change.
Seventeen patients in the control group and 45 in the elderly group
completed the study at six months. The 6-minute walk test (6MWT) increased
in both groups from the initial evaluation to the last one (median value
of 80 m [interquartile range 51] for those under 65 years; 59 m [34] for
the older ones; P=0.114). The 6MWT was also similar after one month of
prehabilitation for both populations. The rate of postoperative
complications was similar in the two groups. Prehabilitation showed
equivalence in patients over 65 years of age compared to younger patients
in terms of increase in functional capabilities and of postoperative
evolution. This multimodal program represents a bundle of care which can
benefit the frailer population.

术前阶段或为通过多模式术前方案优化患者身体状态的适宜时机。本文探讨了‘术前康复（prehabilitation）’方案对老年患者的影响。本单中心观察性队列研究连续纳入139例拟接受大型腹部及胸部手术的患者：对照组（年龄<65岁）44例，老年组（年龄>65岁）95例。所有患者均遵循包含运动训练、营养优化、心理支持及行为改变的术前康复方案。对照组17例患者及老年组45例患者完成了为期6个月的研究。从初始评估到末次评估，两组患者的6分钟步行试验（6MWT）距离均有所增加（65岁以下患者中位数为80米[四分位距51]；老年患者为59米[34]；P=0.114）。经过1个月的术前康复后，两组人群的6MWT结果亦相似。两组患者的术后并发症发生率相似。在功能能力提升及术后转归方面，术前康复对65岁以上患者与年轻患者显示出等效性。该多模式方案是一套整合护理方案，可使更虚弱人群获益。