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. 2023 May 28;12(11):3724.
doi: 10.3390/jcm12113724.

Multimodal Prehabilitation in Heart Transplant Recipients Improves Short-Term Post-Transplant Outcomes without Increasing Costs

Manuel López-Baamonde  1   2   3 , María José Arguis  1   2   3 , Ricard Navarro-Ripoll  1   2   3 , Elena Gimeno-Santos  2   3   4 , Bárbara Romano-Andrioni  2   5   6 , Marina Sisó  2   5   6 , Silvia Terès-Bellès  2   6 , Antonio López-Hernández  1   2 , Adrià Burniol-García  7 , Marta Farrero  8   9 , Raquel Sebio-García  2   3   10 , Elena Sandoval  11 , María Sanz-de la Garza  9 , Julián Librero  12   13   14 , Ana García-Álvarez  9   15 , María Ángeles Castel  8   9   15 , Graciela Martínez-Pallí  1   2   3   16 ; Hospital Clínic de Barcelona Prehabilitation Group (Surgifit)
Collaborators, Affiliations

Multimodal Prehabilitation in Heart Transplant Recipients Improves Short-Term Post-Transplant Outcomes without Increasing Costs

Manuel López-Baamonde et al. J Clin Med. .

Abstract

(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.

Keywords: aerobic capacity; cost-analysis; heart transplantation; postoperative complications; prehabilitation; preoperative optimization.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Probability density distribution of the Comprehensive Complication Index according to prehabilitation intervention. The figure shows the probability density function (PDF) of the CCI score according to prehabilitation intervention. The integral over the entire PDF space (area under the curve) is equal to 1. It can be interpreted as providing a relative likelihood that a person from each group would be close to that CCI unit.
Figure 3
Figure 3
Distribution of costs between groups. The vertical axis shows the proportion of observations in each cost level.
Figure 4
Figure 4
Distribution of bootstrapping results. Red columns represent the iterations where the prehabilitation group had higher costs, and green columns represent those in which the prehabilitation group had lower costs. The black line represents the cumulative distribution of the results, we can see how red columns represent only 38% of iterations. CI: Confidence interval.
See this image and copyright information in PMC

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