Intensive perioperative rehabilitation improves surgical outcomes after pancreaticoduodenectomy

• Published in: Langenbeck's archives of surgery 2018-09, Vol.403 (6), p.711-718
• Main Authors: Kitahata, Yuji, Hirono, Seiko, Kawai, Manabu, Okada, Ken-ichi, Miyazawa, Motoki, Shimizu, Atsushi, Kobayashi, Ryouhei, Ueno, Masaki, Hayami, Shinya, Shimokawa, Toshio, Kouda, Ken, Tajima, Fumihiro, Yamaue, Hiroki
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Cardiac Surgery; Cohort Studies; Female; Follow-Up Studies; General Surgery; Hospital Mortality - trends; Hospitals, High-Volume; Hospitals, University; Humans; Japan; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Original Article; Pancreaticoduodenectomy - methods; Pancreaticoduodenectomy - mortality; Pancreaticoduodenectomy - rehabilitation; Perioperative Care - methods; Physical Therapy Modalities; Postoperative Complications - prevention & control; Recovery of Function - physiology; Reference Values; Retrospective Studies; Statistics, Nonparametric; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-018-1710-1

Purpose Although the mortality rate for pancreaticoduodenectomy (PD) has decreased to around 2.8–5% in high-volume centers, postoperative complications are still common in 30–50% of cases. Preoperative exercise, called “prehabilitation,” has been recently reported to reduce the frequency of complications after surgery. This study aims to evaluate the impact of the intensive perioperative rehabilitation on improvement of surgical outcomes for patients undergoing PD. Methods Between 2003 and 2014, 576 consecutive patients underwent PD in Wakayama Medical University Hospital. Of these, 331 patients received perioperative rehabilitation combined with prehabilitation and postoperative rehabilitation between 2009 and 2014. Previously, 245 patients underwent PD without perioperative rehabilitation between 2003 and 2008. We compared surgical outcomes between the patients undergoing PD with and without perioperative rehabilitation to evaluate the efficacy of our rehabilitation program. Results The frequency of pulmonary complications was significantly lower in patients undergoing PD with perioperative rehabilitation than those without (0.9% vs. 4.3%, P  = 0.011). There were no significant differences in other complication or mortality rates. Length of hospital stay was also shorter in patients receiving perioperative rehabilitation than that of those not receiving it (16 vs. 24 days, P