Introduction: Prehabilitation may benefit older patients undergoing major surgeries. Currently, its
efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation
programme.
Methods: Patients aged 65 years and above undergoing major abdominal surgery between May 2015
and December 2019 in the National University Hospital were included in our institutional programme
that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts
as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy,
nutritional advice and psychosocial support were provided as part of prehabilitation.
Results: There were 335 patients in the prehabilitation cohort and 256 patients whose records were
reviewed as control. No difference in postoperative length of stay (P=0.150) or major complications
(P=0.690) were noted. Patients in the prehabilitation group were observed to ambulate a longer
distance and participate more actively with their physiotherapists from postoperative day 1 until 4. In
the subgroup of patients with cancer, more patients underwent neoadjuvant therapy in the prehabilitation
group compared to the control group (21.7% versus 12.6%, P=0.009). Prehabilitation patients were
more likely to proceed to adjuvant chemotherapy (prehabilitation 87.2% vs control 65.6%, P<0.001) if it
had been recommended.
Conclusion: The current study found no differences in traditional surgical outcome measures with
and without prehabilitation. An increase in patient mobility in the immediate postoperative period was
noted with prehabilitation, as well as an association between prehabilitation and increased adherence
to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of
this retrospective review.
Keywords: Frailty, general surgery, geriatric surgery, perioperative care, prehabilitation