Effect of short-term prehabilitation of older patients with colorectal cancer: A propensity score-matched analysis

Abstract

ObjectiveThe aim of this study was to assess the impact of short-term, hospital-based, supervised multimodal prehabilitation on elderly patients with colorectal cancer.MethodsA single-center, retrospective study was conducted from October 2020 to December 2021, which included a total of 587 CRC patients who were scheduled to undergo radical resection. A propensity score-matching analysis was performed to reduce selection bias. All patients were treated within a standardized enhanced recovery pathway, and patients in the prehabilitation group received an additional supervised, short-term multimodal preoperative prehabilitation intervention. Short-term outcomes were compared between the two groups.ResultsAmong the participants, 62 patients were excluded; 95 participants were included in the prehabilitation group and 430 in the non-prehabilitation group. After PSM analysis, 95 pairs of well-matched patients were included in the comparative study. Participants in the prehabilitation group had better preoperative functional capacity (402.78 m vs. 390.09 m, P<0.001), preoperative anxiety status (9% vs. 28%, P<0.001), time to first ambulation[25.0(8.0) hours vs. 28.0(12.4) hours, P=0.008], time to first flatus [39.0(22.0) hours vs. 47.7(34.0) hours, P=0.006], duration of the postoperative length of hospital stay [8.0(3.0) days vs. 10.0(5.0) days, P=0.007), and quality of life in terms of psychological dimensions at 1 month postoperatively [53.0(8.0) vs. 49.0(5.0), P<0.001].ConclusionThe short-term, hospital-based, supervised multimodal prehabilitation is feasible with a high degree of compliance in older CRC patients, which improves their short-term clinical outcomes.

How much does it cost to be fit for operation? The economics of prehabilitation

“…This review specifically addresses recent evidence related to the economics and the cost effectiveness of surgical prehabilitation. The programs reported either a reduction in healthcare related costs [10,12,14,15] or no impact on them [9 ▪ ,13,16 ▪ ,17,18 ▪▪ ], except one study, which reported no increase in costs only in a subgroup of PG [11]. However, the current studies demonstrate a heterogeneity of the programs‘ structure and of the included population, as a recent systematic review of Rombey et al also debated [6].…”

“…The healthcare cost reduction was mainly achieved by reducing the length of hospitalization [4,10–12,14,16 ▪ ,17]. This would also allow the hospitals to have a higher patient turnover, thus, to generate more income.…”

“…Between January 2022 and October 2023, ten studies have specifically addressed the cost balance of introducing prehabilitation programs before surgery [9 ▪ ,10–15,16 ▪ ,17,18 ▪▪ ]. Various types of programs were evaluated including physical, nutritional, and multimodal (including a combination of physical, nutritional, and psychological support).…”

“…Seven original studies analysed the cost-effectiveness of multimodal prehabilitation programs in patients scheduled for elective major digestive, cardiac, thoracic, gynaecologic surgeries, heart transplant, TKA or cancer treatment [12–15,16 ▪ ,17,18 ▪▪ ]. The studies recorded similar endpoints that included nutritional, physical and psychological status, postoperative complications, LoH and length of ICU stay, hospitalization costs, and quality of life.…”

“…A single centre, retrospective study with propensity score matching analysis, including 587 colorectal cancer patient (95 pairs) scheduled for radical resection, investigated an individualized, short-term, in hospital prehabilitation program, consisting of physical training (aerobic, resistance, and breathing training every day), nutritional support (customized diet plan to improve caloric balance, bowel movement and glycaemic control, additional oral protein supplementation for patients with NRS ≥ 3), and psychological support (mindfulness, targeted counselling, breathing exercises, meditation), conducted over a mean of 7 days (5–12) and ended at least 5 days before the surgery [16 ▪ ]. The data was collected at one month, three and six months postoperatively.…”