More Evidence for Prehab Before Heart Surgery

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A pilot prehabilitation program worked well for a center and its frail patients undergoing coronary artery bypass grafting (CABG).

The 100 surgical candidates who underwent multimodal prehabilitation from September 2020 to July 2021 – a program that included lifestyle counseling, exercise training and other activities – tended to have better perioperative outcomes than a matched historical cohort undergoing CABG from June 2019 to September 2020, said Serdar Gunaydin, MD, PhD, of Ankara City Hospital and Health Sciences University in Turkey.

Preadaptation was associated with earlier extubation after surgery, fewer reoperations and reintubations, and fewer readmissions at 6 months. Additionally, patients with prequalified CABG had shorter ICU stays (35 vs. 58 hours on average) and hospital stays (7.2 vs. 9.2 days), for a reduction of 35, 2% of total treatment costs, Gunaydin reported at the Society of Thoracic Surgeons (STS) virtual meeting.

“We believe that the multimodal prehabilitation associated with ERAS [Enhanced Recovery After Surgery]as a value-based approach, can consistently lead to faster recovery, cost reductions, and increased patient and staff satisfaction in cardiac surgery,” he said.

ERAS pathways offer a multidisciplinary approach to improve patient recovery and reduce surgical complications. Guidelines specific to cardiac surgery currently give prehab a Class IIa recommendation based on limited evidence. That could change in this year’s planned update to the guidelines, Gunaydin suggested.

At his hospital, prehab includes regular supervised endurance and exercise training sessions, physical activity and lifestyle promotion, respiratory physiotherapy, nutritional counseling and mindfulness sessions, in the goal of improving patients’ frailty scores. Gunaydin pointed to the surprising benefit of nutritional support in particular, which has recently become the focus modality.

To date, the Turkish center has performed heart surgeries under the prehabilitation protocol in more than 800 patients. The success rate of implementing the pathway was approximately 75-80% at the start of this study. “Now we are over 90%,” Gunaydin said.

“Your practice setting may be a little different from what we experience in North America, [where] referring cardiologists may not appreciate delaying their patients’ CABG surgery, or family members may not be satisfied with waiting a few weeks for surgery,” said STS session co-host Linda Martin , MD, MPH, from the University of Virginia at Charlottesville.

It was also a problem in Turkey, said Gunaydin, who noted that his group had found that standard patient education helped, as did having a large network of referral cardiologists and cardiac surgeons trained in the field. strict path of prehabilitation.

“You know it’s the right thing to do, but the cardiologist is chomping at the bit to get them into the OR [operating room]”, Martin noted of expectations in the United States

“In America, it’s instant coffee, instant surgery. They won’t wait for anything,” agreed co-moderator J. Michael DiMaio, MD, of Baylor Scott & White Health and Heart Hospital in Plano, Au. Texas.

The study included 100 consecutive frail patients matched to 100 pre-prehab patients at Gunaydin Hospital. The mean ages of the two groups were 79 and 76, and their STS scores were 13 and 14, respectively.

Eight people from the prehabilitation group were ultimately excluded from the analysis due to insufficient follow-up data.

  • Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. To follow

Disclosures

Gunaydin and DiMaio did not report any disclosures.

Martin said he has served on advisory boards for AstraZeneca and On Target Laboratories.

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