Introduction
cardiac, non-cardiac thoracic
RECRUITMENT
Although surgical techniques have advanced such that acute operative risks are usually acceptable, the stress of surgery may overwhelm limited adaptive capacities, meaning that long-term risks of mortality, morbidity, and institutionalization are increased even if surgery is technically successful (Prior research among cardiac, non-cardiac thoracic, orthopedic, and abdominal surgical populations demonstrates that inter-disciplinary rehabilitation strategies deployed after surgery enhance recovery and improve outcomes by optimizing nutrition and by building strength, balance, and cardiorespiratory capacity (Therefore, the purpose of this single-arm pilot study was to examine the feasibility of a novel, multifaceted, home-based prehabilitation intervention designed to improve functional capacity and postoperative outcomes for frail Veterans anticipating major abdominal, urological, thoracic, or cardiac surgery. Prehabilitation included: (a) strength and coordination training; (b) inspiratory muscle training (IMT); (c) aerobic conditioning with a cycle ergometer and/or walking and (d) nutritional coaching and supplementation. Pre- and post-prehabilitation assessments included physical and deficit-accumulation frailty, physical function, respiratory muscle function, nutrition, and several patient-reported outcome measures including health-related quality of life. Postoperative outcomes were measured at 30 and 90 days after surgery. In particular, we aimed to assess the feasibility of this novel prehabilitation intervention by estimating rates of recruitment, retention, and adherence to the intervention, and by measuring changes over time in frailty, physical function, respiratory muscle function, nutrition, and health-related quality of life at baseline, the day of surgery, and 30 and 90 days after surgery.