A How-To Guide to Improving Wound Reconstruction Outcomes Employing a Novel Prehabilitation Protocol

Introduction: Wound reconstruction may be associated with a significant decline in functional capacity. While most procedures are not considered "major", some of these procedures do carry significant risks and have associated morbidity. Prehabilitation is defined as a series of activities designed to enhance an individual’s functional capacity to enable them to withstand a forthcoming stressor. Most prehabilitation programs have moved towards a multimodal approach, including medical optimization, preoperative physical exercise, nutritional support, and stress/anxiety reduction. We have recently implemented such a protocol in our wound reconstruction program.

Methods: We developed detailed goals for a prehabilitation program including:Improving cardiovascular, pulmonary, and/or musculoskeletal function. Improve balance and reduce the risk of falls. Reduce anxiety and improve coping with specific cognitive-behavioral strategies. Improve quality of sleep with sleep hygiene education. Optimize surgical outcomes with smoking cessation interventions. Optimize diet with nutrition counseling. Educate around postoperative routines to prepare a safe home environment. The program was designed to occur over an eight-week period. The patients then underwent their scheduled procedures. Outcome variables including hospital length of stay, re-operation within 30 days, major complications, and minor complications were measured. A historical cohort of similar preoperative morbidity-matched was used as a source for control data. https://photos.app.goo.gl/Nfr3Mj8ZSa3BVQLa9

Results: Our presentation shall detail the steps required to develop and implement a prehabilitation protocol including a list of required stakeholders, important constituents, and outcome measures. https://photos.app.goo.gl/bpZYVmZ2HRE7Hg2H7

Discussion: In our study, a prehabilitation protocol reduced complications and improved overall satisfaction with complex procedures. While there was almost certainly an increase in preoperative functional capacity in our study patients, this was not discretely measured. As has been well established with enhanced recovery after surgery protocols, a more rapid return to functional capacity after surgery is considered a major factor in complication reduction. With prehabilitation, the patient's preoperative functional capacity is increased. This implies that the physiologic impact of surgery reducing functional capacity results in higher postoperative capacity, and a likely quicker return to baseline capacity.