Online first
Original article
Published online: 2024-10-01

open access

Page views 63
Article views/downloads 29
Get Citation

Connect on Social Media

Connect on Social Media

The role of prehabilitation in reducing the incidence of postoperative pulmonary complications in patients undergoing elective cardiac surgery: Results from the Pre Surgery Check Team study

Dorota Sobczyk12, Jacek Osiewalski3, Hubert Hymczak45, Dominika Batycka-Stachnik2, Sylwia Wiśniowska-Śmiałek2, Bogusław Kapelak2, Krzysztof Bartuś2

Abstract

Background: Despite its importance, prehabilitation, has only been implemented in very few cardiac surgery centers.

Aims:  The Pre Surgery Check Team study was designed to evaluate the impact of comprehensive interdisciplinary assessment and implementation of the prehabilitation program on the incidence of postoperative pulmonary complications after elective cardiac surgery.

Methods: 725 adult patients (338 in the study group, 387 in the control group) were included in this single-center, prospective, observational study. Multimodal prehabilitation consisted of four elements: interdisciplinary medical assessment by cardiologist, anesthesiologist and cardiac surgeon, pulmonary assessment for patients at high risk of postoperative pulmonary complications,  psychological assessment, and physiotherapeutic assessment and training. The primary endpoint was the occurrence of the postoperative pulmonary complications, and the secondary outcomes were: surgical site infection, rethoracotomy, ICU length of stay and hospital length of stay.

Results: Prehabilitation reduced the number of postoperative complications by 23%. Postoperative pneumonia was almost 3 times less common (5.33% vs 14.21%), and the surgical site infection - 1.4 times less common in the PreScheck group (8.28 vs 11.37%). In the logistic regression model, prehabilitation reduced the odds of postoperative pneumonia (by 0.346) and the odds of respiratory failure (by 0.479). Prehabilitation had no direct effect on  ICU length of stay.

Conclusions: Prehabilitation according to the Pre Surgery Check Team standard reduces the incidence of postoperative pulmonary complications and the total number of postoperative complications in patients undergoing elective cardiac surgery. The main benefit of attending the PreScheck Team visit is the opportunity to perform supportive preoperative interventions.

Article available in PDF format

View PDF Download PDF file

References

  1. Tanner TG, Colvin MO. Pulmonary complications of cardiac surgery. Lung. 2020; 198(6): 889–896.
  2. Fischer MO, Brotons F, Briant AR, et al. VENICE study group. Postoperative pulmonary complications after cardiac surgery: the VENICE international cohort study. J Cardiothorac Vasc Anesth. 2022; 36(8 Pt A): 2344–2351.
  3. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017; 118(3): 317–334.
  4. Sobczyk D, Hymczak H, Batycka-Stachnik D, et al. Is a heart team enough? The role of an interdisciplinary preoperative patient health check in the final qualification for elective cardiac surgery: pre-surgery check team study. Kardiol Pol. 2023; 81(10): 1009–1011.
  5. Sobczyk D, Hymczak H, Batycka-Stachnik D, et al. PreScheck Team Study: prehabilitation clinic as an effective patient management tool in elective cardiac surgery. Anaesthesiol Intensive Ther. 2024; 56(1): 28–36.
  6. Lai FY, Abbasciano RG, Tabberer B, et al. Steering Group of the James Lind Alliance Heart Surgery Priority Setting Partnership. Identifying research priorities in cardiac surgery: a report from the James Lind Alliance Priority Setting Partnership in adult heart surgery. BMJ Open. 2020; 10(9): e038001.
  7. Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015; 2015(10): CD010356.
  8. Hulzebos EHJ, Smit Y, Helders PP, et al. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev. 2012; 11(11): CD010118.
  9. Snowdon D, Haines TP, Skinner EH. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review. J Physiother. 2014; 60(2): 66–77.
  10. Marmelo F, Rocha V, Moreira-Gonçalves D. The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: systematic review and meta-analysis. Eur J Prev Cardiol. 2018; 25(4): 404–417.
  11. Kendall F, Oliveira J, Peleteiro B, et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis. Disabil Rehabil. 2018; 40(8): 864–882.
  12. Akowuah EF, Wagnild JM, Bardgett M, et al. PREPs Trial investigators. A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery. Anaesthesia. 2023; 78(9): 1120–1128.
  13. Kondrup J, Rasmussen HH, Hamberg O, et al. Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003; 22(3): 321–336.
  14. Matthews CE, Patel S, Saint-Maurice PF, et al. Physical Activity Levels (PAL) in US Adults-2019. Med Sci Sports Exerc. 2023; 55(5): 884–891.
  15. Jammer Ib, Wickboldt N, Sander M, et al. European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM), European Society of Anaesthesiology, European Society of Intensive Care Medicine. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol. 2015; 32(2): 88–105.
  16. Brogi E, Gargani L, Bignami E, et al. Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment. Crit Care. 2017; 21(1): 325.
  17. Greene WH. Econometric Analysis, 6th edition. Pearson Prentice Hall, Upper Saddle River 2008.
  18. Hulzebos E, Helders P, Favié N, et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery. JAMA. 2006; 296(15): 1851–1857.
  19. Harrison SL, Loughran KJ, Trevis J, et al. Experiences of patients enrolled and staff involved in the prehabilitation of elective patients undergoing cardiac surgery trial: a nested qualitative study. Anaesthesia. 2023; 78(10): 1215–1224.
  20. Steinmetz C, Heinemann S, Kutschka I, et al. PRECOVERY investigators. Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial. Trials. 2023; 24(1): 533.
  21. Gibbison B, Murphy GJ, Akowuah E, et al. Pre-operative and prehabilitation services in UK cardiac surgery centres. Anaesthesia. 2023; 78(3): 388–391.