Prehabilitation improves surgical outcomes for patients with sarcopenia

A prehabilitation program that integrates exercise and nutritional interventions helps reduce postoperative morbidity in patients with sarcopenia undergoing major liver resection, according to a study.

The study included 70 adult patients who were scheduled for major liver resection and required future liver remnant hypertrophy. All of them had radiologically and functionally confirmed sarcopenia. These patients were randomly assigned to either undergo structured prehabilitation or receive standard perioperative care (control).

Structured prehabilitation was a 6-week program conducted while awaiting liver remnant hypertrophy. The program included daily walking, supervised biweekly in-hospital exercise, and branched-chain amino acid and immune nutritional supplementation.

The primary outcome of 90-day postoperative morbidity was evaluated using the Clavien-Dindo classification.

Of the patients, 60 (median age 69 years, 53.3 percent male) were included in the final analysis. Portal vein embolization was performed in 86.7 percent of patients, and right hepatectomy was performed in 88.3 percent.

Overall morbidity at 90 days after the procedure was significantly reduced in the prehabilitation group than in the control group (13.3 percent vs 50 percent; odds ratio, 0.15, 95 percent CI, 0.04–0.55; p=0.004), with an absolute risk reduction of 36.7 percent and number needed to treat of 3. Major complications occurred only in the control group (0 percent vs 20 percent; p=0.02).

Patients in the prehabilitation arm saw significant improvements in muscle mass and strength. This benefit was not observed in the control group.