Semisupervised home-based prehabilitation in patients undergoing pancreaticoduodenectomy: Impact on postoperative outcomes

Background

Prehabilitation is a relatively newer concept of utilizing the preoperative period for patient optimization to enhance the patient's physiological reserve. We planned a study to see the impact of a structured, multidimensional prehabilitative intervention on postoperative outcomes in patients undergoing pancreaticoduodenectomy.

Methodology

All consecutive patients planned for pancreaticoduodenectomy from January 2023 to June 2024 were assessed for enrollment. At least 2 weeks of semisupervised home-based prehabilitative intervention was done that included physical exercises, nutritional optimization, smoking cessation, and comorbidity optimization. Postoperative outcomes were recorded that included postoperative pancreatic fistula (POPF), complications grade, delayed gastric emptying, postoperative hospital stay, readmission rate, and mortality. Postoperative outcomes were compared with a historical control group of 81 patients.

Results

Of the 85 patients who were assessed for inclusion, 58 patients completed the prehabilitation program and underwent pancreaticoduodenectomy and were finally analyzed. The median age of the study group was 58 (interquartile range 45, 63.2), and 29 (50%) were male. Prehabilitation intervention resulted in improved weight control (median 56.5 kg [interquartile range 51.2, 67] vs 55 kg [ 49.2, 67.5], P < .001), increase in breath hold time (median 32 [interquartile range 28, 35] vs 28 [24, 33.5] seconds, P < .001), higher prognostic nutritional index (median 45.5 [interquartile range 39.5, 49.6] vs 47.8 [42.4, 50.8], P = .003), and increased gait speed (median 0.66 [interquartile range 0.58, 0.75] vs 0.54 [0.50, 0.66] m/s, P = .001). Clinically relevant postoperative pancreatic fistula (18 [22.2%] vs 11 [19%], P = .64) and major complications were similar between the prehabilitation and control groups (17 [29.3%] vs 24 [29.6%], P = .96). The mortality in the control group was higher compared with that in the prehabilitation group (6.3% vs 1.7%).

Conclusion

Semisupervised home-based prehabilitation is effective in improving physiological parameters and functional capacity in pancreaticoduodenectomy. However, establishing the definite role of prehabilitation in pancreaticoduodenectomy to improve postoperative outcomes needs a large randomized study.