Structured presurgery prehabilitation for aged patients undergoing elective surgery significantly improves surgical outcomes and reduces cost: A nonrandomized sequential comparative prospective cohort study

Abstract

Background With increasing global life expectancy, the number of major surgeries performed on aged adults invariably increases. This study aimed to examine the effectiveness of a structured prehabilitative program for aged colorectal cancer patients in improving short‐term surgical outcomes. Methods A prospective philanthropically sponsored Programme for Enhanced Elderly Recovery at Sengkang General Hospital (PEERS) was initiated in February 2017 for patients ≥70‐years‐old who were due to undergo elective colectomies. These patients were put through a 2‐ to 4‐week‐long program before surgery, which included geriatric assessment, nutrition supplementation, and resistance training. They were compared with patients from a similar age group before PEERS was introduced (non‐PEERS). Results Fifty‐eight patients, with a median age of 78.5 (70–93) years, were recruited from a single institution to undergo PEERS. Baseline characteristics between the groups were similar. There was no significant improvement of anthropometric and functional characteristics before and after PEERS. Duration of hospitalization was shorter in the PEERS group (9 vs 11 days, P = 0.01). Both groups had similar 30‐days’ morbidity rates (8.6% vs 17.4%, P = 0.26). The PEERS group had significant improvement in their median EuroQol‐5 Dimension score (0.70 presurgery to 0.80 6‐months’ postsurgery, P = 0.01). After multivariate analysis, the average duration of hospitalization in the PEERS group was 6.8 days shorter (P = 0.018; CI, 1.2–12.4) after adjusting for modality of surgery and complications. This represented a cost saving of USD$11,838.80. Conclusion A standardized prehabilitation program for aged adults reduced the duration of hospitalization, improved the quality of life after surgery, and reduced costs.

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

“…Among the identified studies, there were 15 RCTs [58,59,[61][62][63][64][65][66][67][68][69][70][71][72][73], 6 observational cohort studies [74][75][76][77][78][79], 3 before-and-after studies [80][81][82], 2 pilot studies [60,83], 1 descriptive comparison study [84], 1 prospective observational study [85] and 1 secondary analysis study (of RCT) [86].…”

“…-Problems with eating/feeding-Incontinence-Confusion-Evidence of Falls-Skin Breakdown; TFFS: Treatment Failure-Free Survival; VES-13: Vulnerable Elders Survey. White rows: cost-sensitive measures (measures of patient health conditions leading to cost-increasing or cost-decreasing effects); grey rows: measures of effectiveness of CGA intervention (with the estimation of costs in two studies [81,86]).…”

“…The cancer site considered is colorectal cancer (CRC) in 10 studies [59,60,64,67,75,[77][78][79][80][81]; CRC or esophagogastric cancer in 1 study [82]; gastrointestinal cancer (GI) in 1 study [72]; GI, gastro-urinary (GU) or breast cancer in another study [73]; GI or lung cancer in another study [70]; GI or other sites in another study [74]; GU, bladder, kidney or NSCLC in another study [69]; head and neck, lung, upper GI or CRC in another study [71]; NSCLC in another study [66]; prostate, lung, haematologic, GI, head/neck, bladder, renal and other sites in another study [86]; lymphoma, leukaemia or multiple myeloma in another study [65]; solid cancers in 4 studies [61,63,83,85]; solid cancers or lymphoma in another 4 studies [58,62,68,84] and different malignant neoplasms in another study [76].…”

“…The included studies published using data from Europe (12 studies [63,[66][67][68][69]71,75,[77][78][79][80]85]), followed by the USA (9 studies [28,61,62,70,72,83,84,86,90]), Hong Kong (2 studies [59,60]), the UK (2 studies [74,82]), Australia (1 study [58]), Canada (1 study [73]), Japan (1 study [64]) and Singapore (1 study [81]). Four articles were published between 2005 and 2014 [60,63,68,86], ten between 2015 and 2018 [59,64,66,73,74,77,79,[82][83][84] and fifteen between 2019 and 2022 [28,58,61,62,67,…”

“…The first was a nonrandomised prospective before-and-after study conducted by Koh and colleagues that recruited 81 patients (≥70-years) with resectable colorectal cancer (CRC) scheduled for elective colectomy [81]. The geriatric intervention consisted of a standardised prehabilitation program (Programme for Enhanced Elderly Recovery at Sengkang General Hospital-PEERS).…”