Ottawa Hospital Research Institute

Assistant Professor, Anesthesiology

University of Ottawa

Junior Research Chair in Perioperative Health Systems and Outcomes
University of Ottawa
Ottawa, Ontario, Canada

A PSH for the Frail Elderly (Phase 3): Prehabilitation of Frail Elderly

The rapid aging of our population means that anesthesiologists care for elderly patients with increasing regularity. Although age is an independent predictor or adverse postoperative outcomes, significant outcome variation exists among older surgical patients. Frailty, a syndrome that describes am aggregate susceptibility to adverse health outcomes due to age-, and disease-related deficits that accumulate across multiple domains is a key predictor of adverse postoperative outcomes in elderly patients. Frail surgical patients are at increased risk of complications, institutionalization, death, and are high healthcare resource users. Multiple stakeholders, including anesthesiologists and patients, have identified improving the outcomes of older patients and preoperative exercise training (prehabilitation) as 2 of the 10 most important areas for future perioperative research. Physical vulnerability is an important aspect of the frailty syndrome, and may be amenable to structured exercise therapy. However, the evidence for preoperative exercise training (prehabilitation) improving postoperative outcomes is obscured by methodological limitations and a focus on non-elderly patients. Recently, evidence has emerged that older and sicker patients may benefit most from prehab, however, this hypothesis has not been formally tested. Because the complex needs of frail perioperative patients require a longitudinal and multidisciplinary approach, our research group is developing a perioperative surgical home for the frail elderly (PSH-Frail). Development of the PSH-Frail is supported by a robust data collection system, including linkage of prospectively collected data to health administrative data infrastructure to improve efficiency and long-term follow up. We hypothesize that prehabilitation will be a vital intervention supported by the PSH frail, however, high quality evidence from randomized trials is needed to support its efficacy. Therefore, we propose a single center randomized controlled trial of prehabilitation of frail elderly patients having elective intraperitoneal cancer surgery to improve postoperative function (primary outcome), and to decrease postoperative resource utilization (secondary outcomes).