PP309 - PERIOPERATIVE MULTIMODAL PREHABILITATION AND POSTOPERATIVE FRAILTY IN OLDER ABDOMINAL SURGERY PATIENTS: A RANDOMIZED CONTROLLED TRIAL

PP309

PERIOPERATIVE MULTIMODAL PREHABILITATION AND POSTOPERATIVE FRAILTY IN OLDER ABDOMINAL SURGERY PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Y. Li^1,2,*, M. Zhu¹

¹Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, ²Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

Rationale: Frailty is common in older adults undergoing major abdominal surgery and is associated with complications, prolonged stay and poor recovery, while the benefit of multidimensional perioperative rehabilitation remains uncertain.

Methods:  In a single-centre randomized trial, 100 prefrail or frail older adults undergoing major abdominal surgery were allocated 1:1 to multidimensional perioperative rehabilitation or usual care. The programme combined graded nutritional support (ONS with EN/PN if needed), structured aerobic and resistance exercise and psychological support, with adherence reinforced by telephone/WeChat; controls received standard perioperative care. The primary outcome was 30-day frailty improvement (≥1-point reduction in Fried score); secondary outcomes were 30-day Clavien–Dindo II–V complications, readmission and postoperative length of stay.

Results: Eighty-three patients completed follow-up (rehabilitation n = 42; usual care n = 41) with comparable baseline characteristics. At 30 days, frailty improvement was higher with rehabilitation (47.6% vs 17.1%; P = 0.005), with fewer patients worsening (23.8% vs 53.7%) or remaining frail (26.2% vs 48.8%; P = 0.035), as shown in the accompanying figure. Walking speed, physical activity and exhaustion improved more, whereas weight-loss and handgrip-strength components were similar. The 30-day complication rate was lower but non-significant (4.8% vs 19.5%; P = 0.084), readmission was comparable, postoperative stay was shorter (8.29 ± 3.57 vs 11.54 ± 9.29 days; P = 0.041), and losses in weight and BMI were attenuated.

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Conclusion: Multidimensional perioperative rehabilitation improved frailty and reduced postoperative stay in prefrail and frail older adults undergoing major abdominal surgery, without increasing complications or readmissions.

Disclosure of Interest: None declared