Prehabilitation to enhance postoperative recovery for an octogenarian following robotic-assisted hysterectomy with endometrial cancer.
OBJECTIVE
Postoperative complications represent a major concern for elderly patients. We report a case of a medically complex and frail 88-yr-old woman with endometrial cancer who was scheduled for a robotic-assisted total abdominal hysterectomy. In addition to her cardiac morbidity she presented with several risk factors for neurocognitive decline, including prior episodes of postoperative delirium.


METHODS
The patient underwent functional, nutritional, and neuropsychological assessments prior to a three-week prehabilitation home-based program consisting of strength and endurance exercises as well as nutritional optimization. Remarkably, there were no episodes of postoperative confusion, and over the following eight weeks, she continued to show sustained improvement in exercise tolerance (as per the six-minute walk test), cognitive function (as per the Repeatable Battery for the Assessment of Neuropsychological Status), and overall functional capacity (Short Form-36).


CONCLUSIONS
This report provides suggestive evidence that a prehabilitation program optimized the health of this elderly patient and may have prevented a further episode of postoperative delirium. Prehabilitation protocols should be evaluated in clinical trials to evaluate their efficacy and the target populations who may benefit and to elucidate the underlying mechanisms responsible for enhanced recovery in the perioperative setting.
Department of Anesthesia, McGill University Health Centre, 1650 Cedar Ave, Room D10-144, Montreal, QC, H3G 1A4, Canada. Franco.Carli@McGill.Ca
Franco
F
Carli
Russell
R
Brown
Stephan
S
Kennepohl
D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control; D016889:Endometrial Neoplasms / Q000601:surgery*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010807:Physical Endurance / Q000502:physiology; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D055070:Resistance Training / Q000379:methods; D012307:Risk Factors; D012371:Robotics