Feasibility and Preliminary Outcomes of a Multimodal Preoperative Rehabilitation Program in a Veteran Population

INTRODUCTION: Multimodal preoperative rehabilitation (MPR) has the potential to improve physiologic reserve and decrease postoperative adverse events. The objective of this study was to determine the feasibility of implementing a self-directed MPR protocol for elective surgical patients and preliminarily compare outcomes with non-MPR patients. METHODS: In collaboration with the geriatrics department, an MPR program was implemented at a single Veterans Affairs hospital in elective surgical patients 3 to 4 weeks before planned intervention. Enrolled patients (n = 38) underwent assessment and treatment of cardiopulmonary function, nutrition, sleep hygiene, mental health, polypharmacy, and frailty using Risk Analysis Index (RAI). Compliance with the MPR protocol was recorded by patients. Composite adverse events at 14 days and length of stay (LOS) were collected for MPR patients who met this milestone (n = 23) and non-MPR patients (n = 17). RESULTS: The overall compliance of MPR patients was 88.6%. Elective surgery was postponed in 3 patients (7.9%) related to undiagnosed conditions. The average frailty score (RAI) was 11.5 ± 6.4 for the MPR group and 10.5 ± 6.1 for the non-MPR group. The type of operation (general/orthopaedic/vascular) was similar between groups: MPR 43/39/17%; non-MPR 47/35/18%. The composite adverse event rate and LOS for each group were as follows: MPR 4.5% and 1.5 ± 1.7 days; non-MPR 11.8% and 1.6 ± 1.9 days. CONCLUSION: An MPR protocol can be implemented into surgical practice, and patients demonstrate excellent compliance. Research is ongoing to determine the role of multimodal preoperative rehabilitation in a frail population by further evaluating postoperative outcomes and quality of life.