Fit for surgery? Evidence supporting prehabilitation programs

We read with interest the article ‘Fit for surgery? Perspectives on preoperative exercise testing and training’ published recently in the British Journal of Anaesthesia. Richardson and colleagues1Richardson K. Levett D.Z.H. Jack S. Grocott M.P.W. Fit for surgery? Perspectives on preoperative exercise testing and training.Br J Anaesth. 2017; 119: i34-43Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar provide profound insights on preoperative cardiopulmonary exercise testing and exercise training interventions (prehabilitation), and stress the fact that most publications on prehabilitation are feasibility or pilot studies, underpowered to assess clinical outcomes. However, this review fails to mention a recent randomised controlled trial published online ahead of print by our group.2Barberan-Garcia A. Ubré M. Roca J. et al.Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial.Ann Surg. 2018; 267: 50-56Crossref PubMed Scopus (390) Google Scholar We showed that a prehabilitation programme including both supervised high-intensity exercise training and promotion of physical activity reduced postoperative complications by 51% in high-risk patients undergoing elective major abdominal surgery. The methodological strengths of our clinical trial overcome limitations observed in previous publications as pointed out in the review by Richardson and colleagues,1Richardson K. Levett D.Z.H. Jack S. Grocott M.P.W. Fit for surgery? Perspectives on preoperative exercise testing and training.Br J Anaesth. 2017; 119: i34-43Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar as the sample size was powered for postoperative complications, using blinded evaluation and ensuring no contamination between study groups. Moreover, the robustness of our findings is supported by the consistency between intention-to-treat, per-protocol, and sensitivity analysis, providing strong evidence to support a relationship between enhanced aerobic capacity and improved postoperative clinical outcomes. In agreement with Richardson and colleagues,1Richardson K. Levett D.Z.H. Jack S. Grocott M.P.W. Fit for surgery? Perspectives on preoperative exercise testing and training.Br J Anaesth. 2017; 119: i34-43Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar multicentre studies assessing the impact of prehabilitation are required. However, it is important to highlight that our recently published clinical trial, not included in their review, provides valuable information supporting the effectiveness of prehabilitation to reduce postoperative complications in major abdominal surgery. We have no conflict of interest to declare.