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PubMed · 42600564

Impact of a multimodal prehabilitation program on postoperative cognitive dysfunction: a single-center randomized controlled trial.

Juan Perdomo-Linares·Manuel López-Baamonde·Ricard Mellado-Artigas·Adrià Tort-Merino·Laura Garavito-Henao·María José Arguis·Ricard Navarro-Ripoll·Antonio López-Hernández·Mircea Balasa·Eva Rivas·Graciela Martínez-Pallí
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Abstract

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a frequent complication after cardiac surgery. Exercise-based prehabilitation may enhance functional reserve and reduce vulnerability to perioperative cerebral insults. We hypothesized that multimodal prehabilitation reduces POCD 3&#xa0;months after cardiac surgery. METHODS: This prespecified substudy of a single-center randomized controlled trial (NCT03466606) included patients aged &#x2265;50&#xa0;years undergoing elective coronary artery bypass grafting and/or valve surgery. Participants were randomized 1:1 to 4-6&#xa0;weeks of multimodal prehabilitation (exercise training, nutritional support, and psychological support) or standard preoperative care. Cognitive function was assessed at baseline and 3&#xa0;months postoperatively using an age- and education-adjusted neuropsychological battery. POCD was defined as performance &#x2265;1.5 standard deviations below normative values in at least 2 cognitive tests, excluding the Mini-Mental State Examination. Logistic regression analyses were performed to evaluate factors associated with POCD. RESULTS: Of 160 participants screened from the parent trial, 134 met eligibility criteria for the substudy and were randomized; 116 completed 3-month follow-up (prehabilitation n&#xa0;=&#xa0;53; control n&#xa0;=&#xa0;63). POCD occurred in 29 patients (25%), including 15/53 (28%) in the prehabilitation group and 14/63 (22%) in controls (odds ratio [OR] 1.37, 95% confidence interval [CI] 0.54-3.50, P&#xa0;=&#xa0;0.52). In multivariable analysis, preoperative cognitive impairment was independently associated with POCD (OR 13.28, 95% CI 4.06-43.41, P&#xa0;<&#xa0;0.001), whereas prehabilitation was not (OR 1.09, 95% CI 0.35-3.45, P&#xa0;=&#xa0;0.877). Higher physical activity levels at 3&#xa0;months were associated with lower odds of POCD (OR 0.97, 95% CI 0.95-1.00, P&#xa0;=&#xa0;0.047). CONCLUSIONS: In this randomized controlled trial, a 4-6-week multimodal prehabilitation program did not reduce postoperative cognitive dysfunction 3&#xa0;months after cardiac surgery. Although the intervention did not achieve measurable cognitive protection, the observed association between postoperative physical activity levels and postoperative cognitive dysfunction warrants further investigation.

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HumansFemalePostoperative Cognitive ComplicationsMiddle AgedMaleAgedPreoperative CareCoronary Artery BypassPreoperative ExerciseNeuropsychological TestsCardiac Surgical ProceduresElective Surgical ProceduresTreatment OutcomeFollow-Up StudiesCognitive EnhancementCardiac surgeryCognitive reserveMultimodal prehabilitationPerioperative neurocognitive disordersPostoperative cognitive dysfunctionJournal ArticleRandomized Controlled Trial

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Juan Perdomo-Linares, Manuel L&#xf3;pez-Baamonde, Ricard Mellado-Artigas, Adri&#xe0; Tort-Merino, Laura Garavito-Henao, Mar&#xed;a Jos&#xe9; Arguis, Ricard Navarro-Ripoll, Antonio L&#xf3;pez-Hern&#xe1;ndez, Mircea Balasa, Eva Rivas, Graciela Mart&#xed;nez-Pall&#xed;. 2026-08-14. Impact of a multimodal prehabilitation program on postoperative cognitive dysfunction: a single-center randomized controlled trial.. https://doi.org/10.1016/j.jclinane.2026.112300

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Journal Article; Randomized Controlled Trial resourceAged subjectCognitive Enhancement subjectCoronary Artery Bypass subjectElective Surgical Procedures subjectFemale subjectFollow-Up Studies subjectHumans subjectJournal Article subjectMale subjectMiddle Aged subjectNeuropsychological Tests subjectPostoperative Cognitive Complications subjectRandomized controlled trials study

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