The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison.
Exercise therapy
Oesophageal cancer
Preoperative care
Surgery
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
05
08
2020
accepted:
10
11
2020
pubmed:
4
12
2020
medline:
30
11
2021
entrez:
3
12
2020
Statut:
ppublish
Résumé
Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive. Between January 2016 and April 2019, all patients with resectable oesophageal cancer who underwent curative treatment at a specialist tertiary centre participated in a personalised, home-based, multimodal prehabilitation programme. Post-operative complications and hospital stay in this group were compared to a control sample. Propensity score matching was used to control for differences in baseline characteristics. Seventy-two patients who completed prehabilitation and 39 control patients were studied; following propensity score matching, there were 38 subjects in each group. In comparison to matched controls, patients in the prehabilitation group had a lower incidence of post-operative pneumonia (prehabilitation = 26%; control = 66%; p = 0.001) and a shorter length of stay (prehabilitation = median 10 days, IQR 8-17 days; control = median 13 days, IQR 11-20 days; p = 0.018). On multivariate regression analysis, participation in prehabilitation was associated with a 77% lower incidence of post-operative pneumonia (OR 0.23, 95% CI 0.09 to 0.55 p = 0.001). There was no significant difference in the incidence of overall complications or severe complications. Prehabilitation was associated with a lower incidence of post-operative pneumonia and shorter hospital length of stay following oesophagectomy. This model of home based, personalised, and supervised prehabilitation is effective and relevant to centralised cancer services.
Sections du résumé
BACKGROUND
Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive.
METHODS
Between January 2016 and April 2019, all patients with resectable oesophageal cancer who underwent curative treatment at a specialist tertiary centre participated in a personalised, home-based, multimodal prehabilitation programme. Post-operative complications and hospital stay in this group were compared to a control sample. Propensity score matching was used to control for differences in baseline characteristics.
RESULTS
Seventy-two patients who completed prehabilitation and 39 control patients were studied; following propensity score matching, there were 38 subjects in each group. In comparison to matched controls, patients in the prehabilitation group had a lower incidence of post-operative pneumonia (prehabilitation = 26%; control = 66%; p = 0.001) and a shorter length of stay (prehabilitation = median 10 days, IQR 8-17 days; control = median 13 days, IQR 11-20 days; p = 0.018). On multivariate regression analysis, participation in prehabilitation was associated with a 77% lower incidence of post-operative pneumonia (OR 0.23, 95% CI 0.09 to 0.55 p = 0.001). There was no significant difference in the incidence of overall complications or severe complications.
CONCLUSION
Prehabilitation was associated with a lower incidence of post-operative pneumonia and shorter hospital length of stay following oesophagectomy. This model of home based, personalised, and supervised prehabilitation is effective and relevant to centralised cancer services.
Identifiants
pubmed: 33269459
doi: 10.1007/s11605-020-04881-3
pii: 10.1007/s11605-020-04881-3
pmc: PMC8602132
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2733-2741Informations de copyright
© 2020. The Author(s).
Références
J Geriatr Oncol. 2016 Nov;7(6):430-436
pubmed: 27452909
Int J Environ Res Public Health. 2014 May 20;11(5):5487-96
pubmed: 24852599
J Gastrointest Surg. 2020 Dec;24(12):2829-2837
pubmed: 31768827
Physiotherapy. 2014 Sep;100(3):196-207
pubmed: 24439570
Acta Oncol. 2019 May;58(5):588-595
pubmed: 30724668
J Gastrointest Surg. 2021 Apr;25(4):890-899
pubmed: 32314231
Ann Surg. 2019 Feb;269(2):291-298
pubmed: 29206677
Eur Radiol. 2014 May;24(5):998-1005
pubmed: 24535076
Eur J Cancer. 2015 Aug;51(12):1538-45
pubmed: 26031552
J Surg Res. 2019 Mar;235:66-72
pubmed: 30691852
Br J Surg. 2015 Aug;102(9):1097-105
pubmed: 26059747
Syst Rev. 2018 Jul 24;7(1):103
pubmed: 30041694
Surg Oncol. 2018 Sep;27(3):584-594
pubmed: 30217322
JAMA Surg. 2016 Jun 1;151(6):538-45
pubmed: 26791334
Br J Surg. 2017 Jun;104(7):802-803
pubmed: 28300279
Dis Esophagus. 2018 Aug 1;31(8):
pubmed: 29846548
World J Surg. 2019 Jul;43(7):1661-1668
pubmed: 30788536
J Clin Oncol. 2013 Nov 1;31(31):3877-82
pubmed: 24062399
Stat Med. 1998 Oct 15;17(19):2265-81
pubmed: 9802183
Br J Anaesth. 2015 Feb;114(2):244-51
pubmed: 25274049
Surg Oncol. 2018 Jun;27(2):289-298
pubmed: 29937184
BMJ. 2010 Apr 27;340:c1900
pubmed: 20423957
J Surg Oncol. 2014 Oct;110(5):599-610
pubmed: 25146593
Eur J Surg Oncol. 2012 Jul;38(7):555-61
pubmed: 22483704
Phys Med Rehabil Clin N Am. 2017 Feb;28(1):49-64
pubmed: 27913000
BMJ. 2017 Aug 8;358:j3702
pubmed: 28790033
Gut. 2011 Nov;60(11):1449-72
pubmed: 21705456
Surgery. 2016 Nov;160(5):1189-1201
pubmed: 27397681
Dis Esophagus. 2017 Jan 1;30(1):1-10
pubmed: 27353216
Eur J Surg Oncol. 2018 Jul;44(7):919-926
pubmed: 29754828
Eur Urol Focus. 2021 Jan;7(1):132-138
pubmed: 31186173
Eur J Surg Oncol. 2014 Oct;40(10):1313-20
pubmed: 24731268
ANZ J Surg. 2017 Mar;87(3):165-170
pubmed: 26477880
Ann Surg. 2015 Aug;262(2):286-94
pubmed: 25607756
Chest. 2012 Dec;142(6):1380-1382
pubmed: 23208333
Br J Surg. 2008 Jan;95(1):80-4
pubmed: 17849373
Best Pract Res Clin Anaesthesiol. 2016 Jun;30(2):145-57
pubmed: 27396803
JAMA Surg. 2018 Dec 1;153(12):1081-1089
pubmed: 30193337
Br J Anaesth. 2000 Jul;85(1):109-17
pubmed: 10927999
Int J Colorectal Dis. 2016 Jul;31(7):1329-39
pubmed: 27112591
Diabetes Care. 2003 Apr;26(4):986-90
pubmed: 12663561
Acta Oncol. 2017 Feb;56(2):295-300
pubmed: 28079430
Ann Surg. 2017 Nov;266(5):822-830
pubmed: 28796017
Anaesthesia. 2017 Dec;72(12):1501-1507
pubmed: 28983904
Best Pract Res Clin Gastroenterol. 2018 Oct - Dec;36-37:61-73
pubmed: 30551858
PLoS One. 2015 Mar 13;10(3):e0121080
pubmed: 25768921