Multi-Therapy Preoperative Preparation Program for Cardiothoracic and Major Surgery (MPMS)

            Jaime Rojas MD*

*Correspondence to: Dr. Jaime Rojas MD, Consultant Cardiothoracic Anaesthesia and Intensive care Medicine – The Beacon Hospital – Dublin Ireland.

Copyright

© 2026 Jaime Rojas MD. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 29 December 2025              

Published: 01 January 2026

DOI: https://doi.org/10.5281/zenodo.18124656

Summary

This article proposal outlines a multidisciplinary Multi?therapy Preoperative Preparation Program for Major Surgery (MPMS) designed for vulnerable, high?risk patients undergoing major elective procedures including cardiac and thoracic surgery. It aims to reduce postoperative complications, ICU and ward length of stay, infections, and healthcare costs, while improving recovery time, survival, quality of life and overall patient experience.

MPMS is a structured, patient?centred prehabilitation pathway that integrates anaesthesiology/intensive care review, comprehensive nutritional assessment and support, psychological optimisation (including anxiety, depression, smoking and alcohol interventions), and targeted physiotherapy?based prehabilitation. It uses frailty and nutritional screening to select candidates, focuses on modifiable risk factors, and embeds robust outcome measurement (clinical events, length of stay, days at home, and patient?reported outcomes) supported by a smartphone application, aligning with contemporary value?based perioperative care models.

The complications after cardiac, thoracic and other  major surgery are widespread causes of admission in intensive care medicine, hospital acquired pneumonia, pulmonary atelectasis, re-do procedures, intrahospital infections, and postoperative morbidity and mortality factors. They increase dramatically the cost of care and affecting the quality of life and functional capacity outcome of our patients.  This is particularly more severe in the high-risk patients with previous major procedures or major pathologies. Postoperative complications are a heavy factor for both the healthcare system and the individual patient and are associated with inferior outcomes and higher healthcare costs. In the United States, a study had a total of 5,880,829 patients undergoing major surgery were included. Particularly the incidence rates of four complications were found to be decreasing: superficial SSI (1.9 to 1.3%), deep SSI (0.6 to 0.4%), urinary tract infection (1.6 to 1.2%), and patient unplanned return to the operating room (3.1 to 2.7%).

When adjusted, regression analyses indicated decreased odds ratios (OR) through the study period years for particularly deep SSI OR 0.92 [0.92–0.93], superficial SSI OR 0.94 [0.94–0.94] and acute renal failure OR 0.96 [0.95–0.96] as the predictor variable (study year) increased (p < 0.01). However, OR’s for organ/space SSI 1.05 [1.05–1.06], myocardial infarction 1.01 [1.01–1.02] and sepsis 1.01 [1.01–1.02] increased slightly over time (all p < 0.01). (1)

The overall outcome of the patient after the procedure is determined by the correct undertaking of the surgical procedure and also by preoperative conditioning and postoperative care. Preoperative preparation decreases the surgical stress response and increases the preparedness of the patient to undergo a planned surgical procedure. Preoperatively structured inspiratory muscle exercises, cardiopulmonary fitness program, and planned exercise program for muscles of limbs, back, abdomen, head, and neck allow an overall upliftment of the physiological capacity of the patient to better cope with the surgical stress. Optimization of dietary status by macronutrients, micronutrients, and protein optimizes the recovery and shortens the overall hospital stay. Preparing patients for the scheduled surgery and alcohol and smoking cessation programs bust the patient's mental health boost the healing process and decrease the risk of mental diseases in the ICU like delirium and depression. This program few weeks before surgery is equally beneficial compared to enhancing operative procedures and postsurgical care. (2).

Along the intrahospital attention many safety and quality measures had been systematically implemented along the last 50 years and the preoperative evaluation is performed rutinary to identify the high-risk patients with good results, however still many patients have still severe complications and complications despite our best efforts even in the best high quality health care systems.

In all the western world does not exist a complete systematic preoperative multidisciplinary program involving psychology, physiotherapy, nutrition, anaesthesiology and internal medicine to prepare patients with high risk for cardiothoracic and major surgery. The idea is to design this program to optimize the clinical condition of our patients increasing the possibility of survival and decrease complications, morbidity and mortality optimizing life quality after the procedure.

Objectives of the Program

1. Reduce the morbidity, mortality, and potential complications after cardiothoracic and major surgery.
2. Reduce the time of recovery after major surgery for high-risk patients
3. Reduce the incidence of post-surgical infections.
4. Create a more pleasant and safe experience for our patients in the hospital.
5. Reduce the cost of health care for the insurance companies and public hospitals.
6. Follow the recovery and quality of life in the short term and middle term after major surgery in high-risk patients to measure the impact of our program.
7. Create and design a new product for our hospital increasing rentability and adding value as a leader in the sector.
8. Reduce ICU and ward time after major surgery.

Definition of Multi-Therapy Preoperative Preparation Program for Multiple Pathology for Major Surgery (MPMS)

MPMS is a tactic of enhancing the general health and well-being of the patient preoperatively to modify the probable risk factors thus uplifting the physiological reserve and decreasing the adverse stress response.

Though surgical interventions are indicated for the cure or palliation of various diseases, the surgery itself acts as an aggressive and stressful event and thus has a deep impact on performance and quality of life postoperatively.  Despite our advancements in anaesthesiology, surgery, intensive care medicine, and perioperative care, many patients don’t achieve functional and physiological recoveries. Different research on adjustable risk factors has identified some protective elements for surgical complications and postoperative recovery, which include good physical fitness, functional reserve, absence of risk habits, weight, and a good level of nutrition. These preoperative factors are vital to