Paradigm shift in gastrointestinal surgery − combating sarcopenia with prehabilitation: Multimodal review of clinical and scientific data

Abstract

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes. These included an increased risk of total complications, major complications, re-admissions, infections, severe infections, 30 d mortality, longer hospital stay and increased hospitalization expenditures. A program to enhance recovery after surgery was meant to address these complications; however, compliance to the program since its introduction has been less than ideal. Over the last decade, the concept of prehabilitation, or “pre-surgery rehabilitation”, has been discussed. The presurgical period represents a window of opportunity to boost and optimize the health of an individual, providing a compensatory “buffer” for the imminent reduction in physiological reserve post-surgery. Initial results have been promising. We review the literature to critically review the utility of prehabilitation, not just in the clinical realm, but also in the scientific realm, with a resource management point-of-view.

Keywords: Sarcopenia; Prehabilitation; Surgery; Frailty; Value; Gastrointestinal surgery

Core Tip: The geriatric surgical population is rapidly growing and hence, clinicians have to take into account additional risk factors such as frailty. In particular, it is evident that sarcopenia is an independent predictive factor of postoperative outcomes. Prehabilitation represents a paradigm shift in geriatric surgical care, with the goal of enhancing functional capacity to withstand a forthcoming stressor. Emerging data has inspired healthcare professionals to not only adopt a multimodal approach, but also to pivot towards personalized programs.