Prehabilitation clinic in cardiac surgery: multidisciplinary protocol for the improvement of postoperative outcomes

Prehabilitation in cardiac surgery is a multidisciplinary approach aimed at optimizing the clinical and functional status of patients awaiting elective procedures. Interventions addressing nutrition, physical activity, psychological support and comorbidity management may improve postoperative outcomes, reduce complications and accelerate recovery. Despite its potential, prehabilitation in cardiac surgery remains scarcely explored and not routinely implemented. The primary objective is to evaluate the impact of a multidisciplinary prehabilitation program in patients undergoing elective cardiac surgery. The study will assess its effect on perioperative clinical outcomes, including the number of red blood cell units transfused from surgical incision until hospital discharge (primary outcome), as well as duration of postoperative mechanical ventilation (hours), length of stay in the intensive care unit and ward (days), total hospital length of stay and the incidence of hospital-acquired infectious complications. This single-center prospective observational study includes a historical control group. Adult patients undergoing elective cardiac surgery at Città di Lecce Hospital, GVM Care & Research, will be consecutively enrolled over six months. Outcomes will be compared with patients treated during the corresponding period of the previous year. We hypothesize that a proportion of patients within the study sample will present with unrecognized iron deficiency and that its correction may reduce the number of perioperative red blood cell units administered. Respiratory training, smoking cessation and controlled physical activity with telemedicine monitoring may be associated with shorter postoperative intubation time. Nutritional supplementation, especially in frail patients, is expected to improve immune competence and reduce surgical site infections. Psychological support may improve adherence and decrease surgery withdrawal while on the waiting list. An economic analysis will assess the feasibility of institutionalizing this clinic in both hospital and online settings. This study may provide evidence supporting prehabilitation as a means to improve perioperative clinical outcomes in cardiac surgery. Positive results could pave the way for systematic implementation of a tele-prehabilitation platform, enabling remote participation and representing an evolution of the perioperative care model. This study protocol has been approved by the local Ethics Committee of Bari (Study ID: 2717/CEL). Registration on ClinicalTrials.gov is ongoing.