Algorithm of Biomarker-based Multimodal Prehabilitation to Reduce Postoperative Delirium and Acute Kidney Injury
DOI:
https://doi.org/10.70577/asce.v5i3.1056Keywords:
prehabilitation; hematologic frailty; biomarkers; postoperative delirium; acute kidney injury; geriatric surgeryAbstract
Postoperative delirium (POD) and acute kidney injury (AKI) are devastating complications in older adults undergoing major surgery. Hematologic frailty, quantifiable through blood biomarkers, reflects diminished physiological reserve and could identify patients with elevated subclinical risk. Biomarker-guided multimodal prehabilitation emerges as a promising strategy, but its efficacy has not been systematically synthesized. To synthesize available evidence on the efficacy of personalized multimodal prehabilitation algorithms guided by hematologic frailty indices to reduce the incidence of POD and AKI in older adults undergoing elective major colorectal surgery. A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches were performed in PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus up to December 2024. Randomized clinical trials and prospective comparative studies evaluating multimodal prehabilitation programs triggered by hematologic biomarkers in adults ≥70 years scheduled for oncologic colorectal resection were included. The primary composite endpoint was the incidence of POD (assessed by CAM-ICU/3D-CAM) or AKI (KDIGO criteria) within 7 postoperative days. A random-effects meta-analysis was performed calculating relative risks (RR) with 95% confidence intervals (CI). Eight studies with 1,240 participants were included. The pooled mean age was 77.8 years. Meta-analysis demonstrated a significant 52% reduction in the composite event (POD or AKI) in biomarker-guided intervention groups compared to standard care (RR: 0.48; 95% CI: 0.35-0.67; p < 0.001; I² = 32%). POD was reduced by 58% (RR: 0.42; 95% CI: 0.28-0.63; p < 0.001) and AKI by 61% (RR: 0.39; 95% CI: 0.24-0.63; p < 0.001). Benefit was most pronounced in patients with intermediate-risk hematologic frailty (RR: 0.31; 95% CI: 0.19-0.51). Hospital stay was significantly shorter in intervention groups (mean difference: -2.3 days; 95% CI: -3.1 to -1.5).Synthesized evidence suggests that biomarker-guided multimodal prehabilitation algorithms significantly reduce the incidence of POD and AKI in older adults undergoing major colorectal surgery. This approach enables efficient allocation of preoperative resources and represents an advance toward precision perioperative medicine.
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Copyright (c) 2026 Andy Alexander Neto Olmos , Andy Jair Cayo Lema , María José Bravo Espinoza , Christopher Andrés Saltos Oña , Daniela Romina Domínguez Ontano
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