Multimodal prehabilitation in heart transplant recipients improves short-term post-transplant outcomes without increasing costs

López-Baamonde, Manuel; Arguis, María José; Navarro-Ripoll, Ricard; Gimeno Santos, Elena, 1980-; Romano, Bárbara; Sisó, Marina; Terès-Bellès, Silvia; López-Hernández, Antonio; Burniol-García, Adrià; Farrero, Marta; Sebio-García, Raquel; Sandoval, Elena; Sanz de la Garza, Maria; Librero, Julián; García-Álvarez, Ana; Castel, María Ángeles; Martínez-Palli, Graciela

doi:http://dx.doi.org/10.3390/jcm12113724

Multimodal prehabilitation in heart transplant recipients improves short-term post-transplant outcomes without increasing costs

Citació

López-Baamonde M, Arguis MJ, Navarro-Ripoll R, Gimeno-Santos E, Romano-Andrioni B, Sisó M, Terès-Bellès S, López-Hernández A, Burniol-García A, Farrero M, Sebio-García R, Sandoval E, Sanz-de la Garza M, Librero J, García-Álvarez A, Castel MÁ, Martínez-Pallí G. Multimodal prehabilitation in heart transplant recipients improves short-term post-transplant outcomes without increasing costs. J Clin Med. 2023;12(11):3724. DOI: 10.3390/jcm12113724

Resum

(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) 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. (3) 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. (4) Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.