de Klerk M, van Dalen D H, Nahar-van Venrooij L M W, Meijerink W J H J, Verdaasdonk E G G
Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
Eur J Surg Oncol. 2021 Nov;47(11):2849-2856. doi: 10.1016/j.ejso.2021.05.033. Epub 2021 May 29.
Up to 50% of the patients experience complications after colorectal cancer (CRC) surgery. Improved preoperative physical and nutritional status can enhance clinical outcomes and reduce postoperative complications. This retrospective, single-center, observational cohort study assessed the impact of a four-week multimodal prehabilitation program on postoperative complications, unplanned readmissions, length of stay, and mortality in elective high-risk CRC patients.
Elective high-risk CRC patients, defined as ASA ≥3 or ≥65yr, who attended the multimodal prehabilitation program (prehabilitation-group) were compared to a historical cohort receiving standard care (control-group). Differences in outcomes between these groups were tested using Fisher's Exact and Mann-Whitney U test. To adjust for confounding, multivariate logistic regression analysis was performed. The main study outcome was the occurrence of postoperative complications. Secondary outcomes included unplanned readmissions, length of hospital stay, and mortality.
351 patients were included (n = 275 control-group, n = 76 prehabilitation-group). The complication rate was lower in the prehabilitation group compared to the control group, 26.3% (n = 20) versus 40% (n = 110) (p = .032). There were fewer unplanned readmissions in the prehabilitation group compared to the control group, 5.3% (n = 4) versus 16.4% (n = 45), p = .014. Median hospital days of stay was 1 day shorter for the prehabilitation-group (p = .004), mortality did not significantly differ between the groups.
This study shows that the used multimodal prehabilitation program leads to a reduction of medical postoperative complications, unplanned readmissions, and shortens the median hospital stay compared with standard care in high-risk CRC patients undergoing elective CRC surgery.
高达50%的患者在结直肠癌（CRC）手术后会出现并发症。改善术前身体和营养状况可提高临床疗效并减少术后并发症。这项回顾性、单中心观察性队列研究评估了为期四周的多模式术前康复计划对择期高危CRC患者术后并发症、非计划再入院、住院时间和死亡率的影响。
将参加多模式术前康复计划的择期高危CRC患者（术前康复组）定义为美国麻醉医师协会（ASA）分级≥3或年龄≥65岁，并与接受标准护理的历史队列（对照组）进行比较。使用Fisher精确检验和Mann-Whitney U检验来检验这些组之间结局的差异。为了调整混杂因素，进行了多变量逻辑回归分析。主要研究结局是术后并发症的发生情况。次要结局包括非计划再入院、住院时间和死亡率。
共纳入351例患者（对照组n = 275，术前康复组n = 76）。术前康复组的并发症发生率低于对照组，分别为26.3%（n = 20）和40%（n = 110）（p = 0.032）。术前康复组的非计划再入院率低于对照组，分别为5.3%（n = 4）和16.4%（n = 45），p = 0.014。术前康复组的中位住院天数短1天（p = 0.004），两组之间的死亡率无显著差异。
本研究表明，与接受标准护理的择期CRC手术高危CRC患者相比，所采用的多模式术前康复计划可减少术后医疗并发症、非计划再入院，并缩短中位住院时间。
