López-Baamonde Manuel, Arguis María José, Navarro-Ripoll Ricard, Gimeno-Santos Elena, Romano-Andrioni Bárbara, Sisó Marina, Terès-Bellès Silvia, López-Hernández Antonio, Burniol-García Adrià, Farrero Marta, Sebio-García Raquel, Sandoval Elena, Sanz-de la Garza María, Librero Julián, García-Álvarez Ana, Castel María Ángeles, Martínez-Pallí Graciela
Anesthesiology and Intensive Care Department, Hospital Clínic, 08036 Barcelona, Spain.
Prehabilitation Group (Surgifit), Hospital Clínic, 08036 Barcelona, Spain.
J Clin Med. 2023 May 28;12(11):3724. doi: 10.3390/jcm12113724.
(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) Methods: This single-center, ambispective cohort study included forty-six candidates for elective heart transplantation from 2017 to 2021 attending a multimodal prehabilitation program consisting of supervised exercise training, physical activity promotion, nutritional optimization, and psychological support. The postoperative course was compared to a control cohort consisting of patients transplanted from 2014 to 2017 and those contemporaneously not involved in prehabilitation. (3) Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, < 0.001) and quality-of-life (Minnesota score 58 vs. 47, 0.046) after the program. No exercise-related events were registered. The prehabilitation cohort showed a lower rate and severity of postoperative complications (comprehensive complication index 37 vs. 31, 0.033), lower mechanical ventilation time (37 vs. 20 h, 0.032), ICU stay (7 vs. 5 days, 0.01), total hospitalization stay (23 vs. 18 days, 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs. (4) Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.
(1) 背景与目的：本研究旨在探讨术前康复对心脏移植术后结局的影响及其成本效益。(2) 方法：这项单中心、双向队列研究纳入了2017年至2021年46例择期心脏移植候选人，他们参加了一个多模式术前康复项目，包括监督下的运动训练、身体活动促进、营养优化和心理支持。将术后过程与一个对照队列进行比较，该对照队列由2014年至2017年接受移植的患者以及同期未参与术前康复的患者组成。(3) 结果：项目实施后，术前功能能力（耐力时间281秒对728秒，<0.001）和生活质量（明尼苏达评分58对47，0.046）有显著改善。未记录到与运动相关的事件。术前康复队列术后并发症的发生率和严重程度较低（综合并发症指数37对31，0.033），机械通气时间较短（37小时对20小时，0.032），重症监护病房住院时间较短（7天对5天，0.01），总住院时间较短（23天对18天，0.008），出院后转至护理/康复机构的需求较少（31%对3%，0.009）。成本后果分析表明，术前康复未增加手术总过程成本。(4) 结论：心脏移植术前的多模式术前康复对术后短期结局有益，可能归因于身体状况的改善，且不增加成本。
