• Vol. 48 No. 11, 386–392
  • 15 November 2019

Prehabilitation and Its Role in Geriatric Surgery

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ABSTRACT

As the world’s population ages rapidly, many elderly people are living to a much more advanced age than before. Consequently, medical conditions that require surgical interventions such as solid organ cancers are also getting more common. While young and fit patients may be able to withstand surgical stresses and recover rapidly after operation, older adults may find these challenging. Rehabilitation that is instituted in the postoperative period aims to help patients regain physical fitness and robustness to preoperative levels. However, recent studies have shown that prehabilitation may be more effective in bringing the fitness level of elderly patients to a higher level before they go for surgery. There are many controversies regarding the effectiveness of prehabilitation, the components of this intervention―be it mono- or multimodalities―and the duration of prehabilitation. This paper looks at the current evidence of this hot topic revolving geriatric surgery.


The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As the life expectancy of the population has improved significantly in the past few decades, a substantial portion of this rapidly ageing population will place a hefty burden on the resources of society, in particular, the healthcare system. Many elderly people are living longer and enjoying a good quality of life. This, however, means that medical conditions requiring surgical care will also rise in similar proportion.

For example, more than half of patients with colorectal cancer in Singapore are >65 years old (50.3% are male and 55.5% are female). About 21.9% of male colorectal cancer patients in Singapore were >75 years old (between 2011 to 2015) and 31.6% of female colorectal cancer patients were >75 years old. Many of these patients required surgery to treat colorectal cancers. Similar patterns were observed in the Western population as well. Cheema et al reported that elderly patients have increasingly frequent access to surgery due to the continuous growth in life expectancy―as an example, almost 40% of colorectal cancers are diagnosed after 75 years and most of them are operated

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