Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity: results of a single-center, blinded, randomized controlled trial

Gloor, Severin; Misirlic, Merima; Frei-Lanter, Cornelia; Herzog, Pascal; Müller, Phaedra; Schäfli-Thurnherr, Judit; Lamdark, Tenzin; Schregel, D; Wyss, Roland; Unger, Ines; Gisi, David; Greco, N.; Mungo, Giuseppe; Wirz, Markus; Raptis, Dimitri Aristotle; Tschuor, Christoph; Breitenstein, Stefan

doi:10.1007/s00423-022-02449-0

Cited by 26 publications

(26 citation statements)

References 25 publications

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“…To note, the last Cochrane review including only 3 Canadian trials, showed, with a low certainty of evidence, that prehabilitation "may reduce" the postoperative complications rate but conversely increases the readmission rate [2]. The absence of selection of high-risk or frail or older patients in most published works as in the present paper [1] can explain the absence of significant effect in the prehabilitation group. One meta-analysis focusing on this population highlighted the suboptimal quality of the included studies, the heterogeneity of interventions and outcome measures [3].…”

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confidence: 57%

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Prehabilitation: better for selected patients

Slim¹

2022

Langenbecks Arch Surg

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confidence: 57%

“…Dear Editor, I read with interest the manuscript published by Gloor S et al [1] reporting the results of a randomized trial on the efficacy of prehabilitation in colorectal surgery. The authors should be congratulated for their effort to conduct such a difficult trial.…”

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confidence: 99%

Prehabilitation: better for selected patients

Slim¹

2022

Langenbecks Arch Surg

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“…6,10,11 Compared with previous studies showing no effect of prehabilitation, this study investigated a multimodal prehabilitation program including supervised high-intensity training. 12,[26][27][28] The concept behind combining multiple interventions, in addition to an Enhanced Recovery After Surgery (ERAS) program, is that of marginal gains. [29][30][31] Although optimizing an individual aspect of care only results in a marginal gain, the aggregation effect of these marginal gains can be considerable.…”

Section: Discussionmentioning

confidence: 99%

“…Patients in the prehabilitation group were older than patients in the control group (p = 0.003) and less likely to use alcohol (p \ 0.001), and had a greater incidence of anemia at the time of inclusion (p = 0.012). The median duration of time between inclusion and surgery was 23 [interquartile range (IQR), [17][18][19][20][21][22][23][24][25][26][27][28][29][30] days in the standard care group and 38 (IQR, 30-48) days in the prehabilitation group.…”

Section: Participantsmentioning

confidence: 99%

Improved Postoperative Outcomes after Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

et al. 2022

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Background The aim of this study was to assess the effect of a multimodal prehabilitation program on perioperative outcomes in colorectal cancer patients with a higher postoperative complication risk, using an emulated target trial (ETT) design. Patients and Methods An ETT design including overlap weighting based on propensity score was performed. The study consisted of all patients with newly diagnosed colorectal cancer (2016–2021), in a large nonacademic training hospital, who were candidate to elective colorectal cancer surgery and had a higher risk for postoperative complications defined by: age ≥ 65 years and or American Society of Anesthesiologists score III/IV. Intention-to-treat (ITT) and per-protocol analyses were performed to evaluate the effect of prehabilitation compared with usual care on perioperative complications and length of stay (LOS). Results Two hundred fifty-one patients were included: 128 in the usual care group and 123 patients in the prehabilitation group. In the ITT analysis, the number needed to treat to reduce one or more complications in one person was 4.2 (95% CI 2.6–10). Compared with patients in the usual care group, patients undergoing prehabilitation had a 55% lower comprehensive complication score (95% CI −71 to −32%). There was a 33% reduction (95% CI −44 to −18%) in LOS from 7 to 5 days. Conclusions This study showed a clinically relevant reduction of complications and LOS after multimodal prehabilitation in patients undergoing colorectal cancer surgery with a higher postoperative complication risk. The study methodology used may serve as an example for further larger multicenter comparative effectiveness research on prehabilitation.

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“…Prehabilitation is a promising and probably mandatory complement to ERAS, because common objectives, in addition to both ERAS and prehabilitation, require active involvement of the patient [ 67 ]. Notwithstanding, conflicting results from recent randomized studies failed to demonstrate clearly the added value of prehabilitation to ERAS, especially in colorectal surgery [ 68 , 69 ]. In consequence, further data from multicentric large-scale trials on major gastrointestinal surgery are upcoming [ 70 ].…”

Section: Future Directionsmentioning

confidence: 99%

Principles of enhanced recovery in gastrointestinal surgery

Roulin

Demartines

2022

Langenbecks Arch Surg

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Background To reduce the impact of surgery-related stress, enhanced recovery after surgery (ERAS) pathways have been developed since over 15 years with subsequent improved postoperative outcome. This multimodal and evidence-based perioperative approach has spread to all fields of gastrointestinal surgery, from esophagus, stomach, duodenum and pancreas, liver, small intestine and colon, and rectum, as well as for other specialties like vascular and cardia surgeries or neurosurgery, among others. Purpose The aim of this state-of-the-art article is to assess current state of evidence on perioperative management specifically in gastrointestinal surgery, with a focus on surgery-related aspects, outcome benefit, and future directions. Conclusion The surgical team must promote continuous improvement of the patient’s ERAS compliance to ensure optimal perioperative care. Everyday clinical practice should be performed according to latest evidence-based medicine and challenging surgical dogma. Moreover, the surgeon must lead and support a multidisciplinary and collaborative teamwork tailored to patient’s need especially with anesthetists and nursing staff.

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Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity: results of a single-center, blinded, randomized controlled trial

Cited by 26 publications

References 25 publications

Prehabilitation: better for selected patients

Prehabilitation: better for selected patients

Improved Postoperative Outcomes after Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

Principles of enhanced recovery in gastrointestinal surgery

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