Preoperative physical activity and functional performance levels are predictors of acute postoperative outcomes in a private South African colorectal cancer cohort

Abstract

Background: For patients with colorectal cancer, surgical resection of the primary tumour remains the best treatment option. Surgery for colorectal cancer is being performed on patients who would previously not have been considered as suitable candidates. It remains to be seen which factors influence hospital length of stay (LOS) and the development of acute postoperative complications in South African patients.Objectives: The objectives of our study were to determine the modifiable factors that influence patients’ development of postoperative complications and hospital LOS and, to identify the types of postoperative complications that develop.Method: A retrospective review and secondary analysis of information in an existing database of patients with colorectal cancer were conducted. Regression analysis statistics were used to determine the predictors of postoperative outcomes. The level of significance at which testing was performed was set at 5% (p ≤ 0.05).Results: Data of 125 patients were included. Surgical site infections and postoperative paralytic ileus were the most frequently reported postoperative complications. Preoperative vigorous-intensity physical activity (p = 0.048, β = -0.000) and functional performance status (p = 0.05, β = 0.926) significantly predicted hospital LOS and the incidence of postoperative complications, respectively.Conclusion: Preoperative physical activity and functional performance levels are predictors of acute postoperative outcomes in a private South African cohort of patients with colorectal cancer. Future research which includes other modifiable factors is required to make informed suggestions for changes in clinical practice.Clinical implications: Patients requiring surgery for colorectal cancer should be screened for signs of physical deconditioning and referred for physiotherapy intervention before elective surgery to optimise their recovery.

Incidence, patterns and factors associated with ileostomy complications in two selected hospitals in Western Uganda

“…Also ileostomies contain digestive juices which cause insult to the skin resulting in skin excoriation (21), and it's not surprising that they were the commonest complication seen. Contrary to our ndings, Whelan et al (23) in south Africa, reported that the commonest stoma complication was high output stoma representing 80% of all complications. This is possibly because they had a big number of patients with a short proximal length of jejunum and ileum left after placement of ileostomy, yet in our study, more than 90% of the participants had more than 3 meters of proximal jejunum and ileum left.…”

Preoperative physiotherapy education for patients undergoing colorectal cancer resection

“…36 Preoperative functional performance levels and physical activity are predictors of acute postoperative outcomes in South African patients undergoing colorectal cancer resection. 5 This supports the decision to include physical activity and information regarding other lifestyle-related factors to effect changes in acute and long-term outcomes in this patient group.…”

“…4 Emerging data from a cohort of patients from a private South African hospital have shown that surgical site infection and postoperative paralytic ileus were the most frequently reported postoperative complications in patients who underwent surgical resection for colorectal cancer. 5 Prehabilitation has been defined as the process of improving an individual's functional capacity to better withstand a stressful event such as surgery. 6 There is research supporting the use of preoperative exercise strategies to optimise overall health and improve postoperative outcomes in patients undergoing surgery for various forms of abdominal cancers.…”

Association between self-assessed preoperative level of physical activity and postoperative complications – An observational cohort analysis within a randomized controlled trial (PHYSSURG-C)

“…They reported that participants with MET 12 had lower risk for overall complications, but that this could not be explained by differences in any specific type of complications. Whelan et al recently reported results from a study on 125 patients with colorectal cancer in South Africa [12]. They reported an association between baseline physical activity and length of hospital stay, but not postoperative complications.…”