The role of prehabilitation in reducing the incidence of postoperative pulmonary complications in patients undergoing elective cardiac surgery: Results from the Pre Surgery Check Team study

Background: Despite its importance, prehabilitation has only been implemented in very few cardiac surgery centers. Aims: The Pre Surgery Check (PreScheck) Team study was designed to evaluate the impact of comprehensive interdisciplinary assessment and implementation of the prehabilitation program on the incidence of postoperative pulmonary complications after elective cardiac surgery. Material and methods: 725 adult patients (338 in the study group, 387 in the control group) were included in this single-center, prospective, observational study. Multimodal prehabilitation involves four elements: interdisciplinary medical assessment by a cardiologist, an anesthesiologist, and a cardiac surgeon, pulmonary assessment for patients at high risk of postoperative pulmonary complications, psychological assessment, and physiotherapeutic assessment and training. The primary endpoint was the occurrence of postoperative pulmonary complications, and the secondary outcomes were surgical site infection, rethoracotomy, length of stay in the intensive care unit, and length of hospital stay. Results: Prehabilitation reduced the number of postoperative complications by 23%. Postoperative pneumonia was almost 3-fold less common (5.33% vs. 14.21%), and surgical site infection - 1.4 times less common in the PreScheck group (8.28 vs. 11.37%). In the logistic regression model, prehabilitation reduced the odds of postoperative pneumonia (by 0.346) and the odds of respiratory failure (by 0.479). Prehabilitation had no direct effect on the length of stay in the intensive care unit. Conclusions: Prehabilitation, according to the Pre Surgery Check Team standard, reduces the incidence of postoperative pulmonary complications and the total number of postoperative complications in patients undergoing elective cardiac surgery. The main benefit of participating in the PreScheck Team program is the opportunity to receive supportive preoperative interventions.