TY - JOUR
T1 - Multimodal prehabilitation in heart transplant recipients improves short-term post-transplant outcomes without increasing costs
AU - López-Baamonde, Manuel
AU - Arguis, María José
AU - Navarro-Ripoll, Ricard
AU - Gimeno-Santos, Elena
AU - Romano-Andrioni, Bárbara
AU - Sisó, Marina
AU - Terès-Bellès, Silvia
AU - López-Hernández, Antonio
AU - Burniol-García, Adrià
AU - Farrero, Marta
AU - Sebio-García, Raquel
AU - Sandoval, Elena
AU - Sanz-de la Garza, María
AU - Librero, Julián
AU - García-Álvarez, Ana
AU - Castel, María Ángeles
AU - Martínez-Pallí, Graciela
N1 - Funding Information:
Funding for the trial was provided by a grant from the Spanish Public Government Fondos de Investigación en Salud (FIS) from Instituto de Salud Carlos III (PI17/00852), after a peer-reviewed process. The grant was awarded as a means for implementing multimodal prehabilitation in cardiac surgery. The present trial is the main receiver of its funds along with the subproject of prehabilitation for cardiac transplant candidates presented in this article. Elena Gimeno-Santos had a competitive personal grant from Instituto de Salud Carlos III, Sara Borrell contract (AES 2013–2016), Government of Spain. Protein supplementation with Fresubin Protein powder was provided and supported by Fresenius-Kabi España. The authors are also grateful for the support from the partners of the PAPRIKA project (https://eithealth.eu/project/paprika (accessed on 20 April 2023)).
Publisher Copyright:
© 2023 by the authors.
PY - 2023/6
Y1 - 2023/6
N2 - Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. 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. Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, p < 0.001) and quality-of-life (Minnesota score 58 vs. 47, p = 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, p = 0.033), lower mechanical ventilation time (37 vs. 20 h, p = 0.032), ICU stay (7 vs. 5 days, p = 0.01), total hospitalization stay (23 vs. 18 days, p = 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p = 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs.Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.
AB - Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. 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. Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, p < 0.001) and quality-of-life (Minnesota score 58 vs. 47, p = 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, p = 0.033), lower mechanical ventilation time (37 vs. 20 h, p = 0.032), ICU stay (7 vs. 5 days, p = 0.01), total hospitalization stay (23 vs. 18 days, p = 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p = 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs.Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.
KW - aerobic capacity
KW - cost-analysis
KW - heart transplantation
KW - postoperative complications
KW - prehabilitation
KW - preoperative optimization
KW - Cost-analysis
KW - Preoperative optimization
KW - Prehabilitation
KW - Heart transplantation
KW - Aerobic capacity
KW - Postoperative complications
UR - https://www.scopus.com/pages/publications/85161288990
UR - https://www.webofscience.com/wos/alldb/full-record/WOS:001004647400001
U2 - 10.3390/jcm12113724
DO - 10.3390/jcm12113724
M3 - Article
C2 - https://pubmed.ncbi.nlm.nih.gov/37297919/
AN - SCOPUS:85161288990
SN - 2077-0383
VL - 12
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 11
M1 - 3724
ER -