Prehabilitation and enhanced recovery after cardiac surgery

Abstract

Cardiac surgery carries substantial risks, particularly for an aging population with increased frailty, morbidity, and malnutrition. Prehabilitation and Enhanced Recovery After Surgery (ERAS) protocols are emerging as essential strategies to optimize patients before surgery and accelerate postoperative recovery. In this review, we explore the role of prehabilitation and ERAS protocols in cardiac surgery, identify the challenges in implementing these strategies, and highlight areas for future research. Prehabilitation involves structured interventions such as physical conditioning, respiratory training, nutritional optimization, psychological support, and lifestyle modifications. While prehabilitation's role in non-cardiac surgery is well-established, its application in cardiac surgery remains less defined due to a lack of high-quality trial data and variability in studies. ERAS protocols, initially designed for colorectal surgery, have been adapted for cardiac surgery to include patient education, early mobilization, multimodal analgesia, and blood conservation techniques. Despite promising evidence regarding prehabilitation and ERAS protocols, the widespread adoption in cardiac surgery has been hindered by patient heterogeneity, limited access, and logistical constraints. The potential benefits include reduced complications, shorter hospital stays, improved recovery, and better patient outcomes. Future research should focus on standardizing prehabilitation protocols, assessing their impact on high-risk populations, and exploring telemedicine solutions to enhance accessibility.