Prehabilitation may improve outcomes and hasten return to pre-operative functional levels following major surgery.
D. Cottam T. Rampal R. Laza-Cagigas M. Shah
CPET/training bike set up
An 81-year-old male with a background of cerebrovascular disease, pulmonary embolism and bladder transitional cell carcinoma was referred to the prehabilitation unit following CPET assessing fitness for cystectomy.
We provided nutritional information, home-based respiratory muscle training instructions, and supervised cycle ergometer interval training (twenty-four 30- minute sessions over eight weeks), and assessed the impact on CPET, laboratory tests and 30-day post-operative mortality estimation.
Presentation of case data along with CPET demonstrations to surgeons and Trust wide educational presentation, we have established links with Surgical schedulers to increase the potential benefit to all major surgical patients.
We continue to invite surgeons and GPs to Patient education evenings and regular promotions in social media and newsletters.
The intervention was well tolerated by the patient. Pre- and post-intervention spirometry, CPET and laboratory data are summarised in table 1. BMI reduced from 30.9 to 29.7 with 3 kg of weight loss. Spirometry values improved post-intervention with increases in FVC, FEV1 and PEF, while CPET demonstrated increases in VO2 Max, minute ventilation and maximum load. Serum creatinine reduced, while albumin and haemoglobin increased post-intervention. The patient’s predicted 30-day mortality fell from 11.5% to 6.14% within 8 weeks.
A structured prehabilitation programme may have the potential to reduce perioperative risk in high risk patients in a hospital with no pre-existing set-up. Following the presentation of the initial proof of concept and collaborative educational sessions for surgeons, we have increased the referral rate into our programme. We have enrolled further patients and continue to review the impact on perioperative mortality.