The importance of prerehabilitation in the reduction of postoperative complications of elderly patients undergoing abdominal operations--systematic review.

The postoperative rehabilitation is indispensable and often key element in the process of recovery after a surgical procedure. It is natural for a patient to go through a rehabilitation cycle after orthopedic procedures to return to motor efficiency or to be taken care by physical therapists after pulmonary operations as part of respiratory rehabilitation. The concept of preoperative rehabilitation is completely different from the conventional, postoperative rehabilitation. However, the preoperative rehabilitation does not involve restoration of functionality of a system or organ that underwent surgical treatment. This one is more holistic and is not targeted to a specific procedure type. Preoperative rehabilitation should include exercises to improve general fitness, respiratory and cardiovascular exercises to prepare a patient to overcome stress related to the surgical procedure. Such thinking limits utility of preoperative rehabilitation to extensive procedures that markedly impair body homeostasis and thus generating high operative stress. Concurrently patients who appear to derive greatest benefits from preoperative rehabilitation include elderly subjects and subjects with cardiovascular, respiratory disorders, motor system disorders who are able to adhere to the prescribed exercise regimen. The aim of the preoperative rehabilitation is to reduce postoperative cardiovascular and respiratory complications, to facilitate postoperative patient mobilization, to shorten duration of the hospitalization and speed up recovery and facilitate postoperative rehabilitation in the long term. The aim of this study was to assess the current knowledge of preoperative rehabilitation among surgical patients referred for abdominal procedures and to assess its effectiveness and effects on postoperative complications. The following electronic databases were searched: PubMed, EMBASE, and The Cochrane Library using the following term combination: preoperative, rehabilitation, preconditioning, exercise, training, physical therapy, physiotherapy, surgery, abdominal, gastric, bowel. Subsequently a preselection of papers was done based on: paper title, abstract, full contents of a research paper. Full versions of papers on the subject matter were subjected to adequate selection. Papers were included if they met the following criteria: – the intervention involved rehabilitation with physical activity directed to improvement of respiratory efficiency, cardiovascular fitness and muscular strength and motor skills in the preoperative period; – the endpoints included: occurrence and type of postoperative complications, duration of hospitalization and related improvement of general fitness. Papers were excluded if: