The association between performance parameters of physical fitness and postoperative outcomes in patients undergoing colorectal surgery: An evaluation of care data

Heldens, A.F.J.M.; Bongers, Bart C.; Lenssen, Antoine F.; Stassen, Laurents P. S.; Buhre, W.; Meeteren, N.L.U. van

doi:10.1016/j.ejso.2017.08.012

Cited by 29 publications

(33 citation statements)

References 31 publications

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“…This might be a possible explanation for the discrepancy between our results and the previously mentioned studies 10,24 . Nevertheless, a recent Dutch study among a similar population of CRC patients published results in line with our findings, as no significant association between pre-operative HGS as a single measurement and the occurrence of postoperative complications was found 6 . On the other hand, the same Dutch study demonstrated a significant association between an overall better pre-operative physical fitness, defined by a combination of physical tests, and a lower incidence of postoperative complications 6 .…”

Section: Discussionsupporting

confidence: 90%

“…Nevertheless, a recent Dutch study among a similar population of CRC patients published results in line with our findings, as no significant association between pre-operative HGS as a single measurement and the occurrence of postoperative complications was found 6 . On the other hand, the same Dutch study demonstrated a significant association between an overall better pre-operative physical fitness, defined by a combination of physical tests, and a lower incidence of postoperative complications 6 . The absence of an association between HGS as a single measurement and the incidence of postoperative complications is in line with the results of our study as well as results from other recent studies that found no association between a pre-operative HGS as a single functional performance measurement, and the occurrence of postoperative complications 26,27 .…”

Section: Discussionsupporting

confidence: 90%

“…The results from such a tool might also be helpful to determine which patients might benefit from tailored prehabilitation programs in order to improve the patient's preoperative functional capacity to withstand the major insult of surgery with less morbidity and better HRQoL 12,13 . Studies investigating the association between HGS and clinical and functional outcomes after CRC treatment are scarce 6,14 . In this prospective cohort study, we determined associations of pre-operative HGS with the occurrence of complications and with HRQoL in non-metastatic CRC patients six weeks after the end of treatment.…”

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confidence: 99%

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Preoperative handgrip strength is not associated with complications and health-related quality of life after surgery for colorectal cancer

Heinsbergen

Konsten

Bours

et al. 2020

Sci Rep

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colorectal cancer (cRc) treatment is associated with a high morbidity which may result in a reduced health-related quality of life (HRQoL). the pre-operative measurement of handgrip strength (HGS) might be a tool to predict the patient's outcome after cRc surgery. the aim of this study was to evaluate the association of pre-operative HGS with the occurrence of postoperative complications and postoperative HRQoL. Stage I to III CRC patients ≥ 18 years were included at diagnosis. Demographic and clinical data as well as HGS were collected before start of treatment. HGS was classified as weak if it was below the gender-specific 25th percentile of our study population; otherwise HGS was classified as normal. The occurrence of postoperative complications within 30 days after surgery was collected from medical records. Cancer-specific HRQoL was measured 6 weeks after treatment using the EORTC QLQ-C30 and the EORTC QLQ-CR29 questionnaire. Of 295 patients who underwent surgical treatment for CRC, 67 (23%) patients had a weak HGS while 228 (77%) patients had normal HGS. 118 patients (40%) developed a postoperative complication. Complications occurred in 37% of patients with a weak HGS and in 41% of patients with a normal HGS (p = 0.47). After adjustment for age, sex, ASA, BMI and TNM, no significant associations between pre-operative HGS and the occurrence of postoperative complications and between HGS and HRQoL were found. We conclude that a single pre-operative HGS measurement was not associated with the occurrence of postoperative complications or posttreatment HRQoL in stage i-iii cRc patients. Colorectal cancer (CRC) is the second commonest cause of cancer death in the Netherlands 1. The number of CRC patients has increased during the past years from 9,106 newly diagnosed patients in 2000 to 15,807 in 2015 2. Up to high age, the vast majority of these patients undergo surgical resection for cure or palliation 3. Unfortunately, CRC surgery is associated with a high complication rate up to 50%, associated with a reduced health-related quality of life (HRQoL), increased hospital costs and even mortality 4,5. Despite the introduction of laparoscopic surgery and the implementation of the Enhanced Recovery After Surgery (ERAS) protocol, certain groups with pre-existent comorbidity and a reduced functional capacity are known to be at risk for the occurrence of postoperative adverse events 6. Preoperative risk stratification remains challenging as the tools used for the risk stratification mainly use traditional and costly examinations such as cardiac and pulmonary functioning and laboratory tests 7. Apart from these examinations, which provide mainly anaesthesiological information on the risk of perioperative adverse events and not outcome after the end of treatment, there is a need for an easy tool

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

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confidence: 99%

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Preoperative handgrip strength is not associated with complications and health-related quality of life after surgery for colorectal cancer

Heinsbergen

Konsten

Bours

et al. 2020

Sci Rep

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“…The TUG test measures the ability to rise from an arm chair (43 to 47 cm in height), walk a short distance (3 m), return to the chair, and sit down again, all as quickly as possible. 6 The TUG test is associated with time to recovery of physical functioning (odds ratio [OR] of 1.274; 95% CI of 0.975 to 1.664; P = .008) scored on the modified Iowa level of assistance scale (mILAS) in patients undergoing colorectal surgery. 7 During the 2MWT, patients have to walk as far as they can in 2 min over a length of 15 m with their customary walking aid, if applicable.…”

Section: Description Of the Examination Strategy Of The Physical Thermentioning

confidence: 99%

Personalized community-based prehabilitation for a high-risk surgical patient opting for pylorus-preserving pancreaticoduodenectomy: a case report

Beijsterveld

Bongers

Dulk

et al. 2020

Physiotherapy Theory and Practice

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Introduction: Prehabilitation aims for an optimal physical functioning level before, during, and after hospitalization for major surgery. The purpose of this case report was to illustrate the care pathway of a high-risk patient who opted for pylorus-preserving pancreaticoduodenectomy, including preparation for this procedure by participating in a community-based exercise prehabilitation program. The report describes patient examination, evaluation in decision-making for surgery, the prehabilitation program, and outcomes within the context of the Hypothesis-Oriented Algorithm for Clinicians II. Case Description: The patient was a 75-year-old woman with a history of several comorbidities and a polypoid mass in the descending segment of the duodenum. Based on the preoperative assessment, the level of physical functioning was expected to be insufficient to cope adequately with the stress of hospitalization and surgery. Intervention: A 4-week prehabilitation program, including aerobic, resistance, and functional task training in a community-based physical therapy practice. Outcomes: Prehabilitation had a beneficial impact on improving functional mobility preoperatively (timed up-and-go test score improved from 19.4 to 10.0 s, five times sit-to-stand test score improved from 30.1 to 10.1 s, and two-minute walk test distance improved from 55.0 to 107.0 m). Surgery and postoperative recovery proceeded without complications. She achieved independent physical functioning on postoperative day 6 and was discharged home on postoperative day 12. Conclusion: Preoperative risk-assessment can support clinical decision-making in a high-risk patient opting for major abdominal surgery. Furthermore, a remarkable improvement in physical functioning can be achieved by community-based prehabilitation in a high-risk surgical patient.

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“…However, the impact on postoperative outcomes in elderly patients with CRC has never been quantitatively examined by using formal frailty assessment instrument(s) [7]. Also, the underlying mechanisms by which frailty confer a poorer prognosis need to be determined yet [8][9][10]. In this systematic review and meta-analysis, we aimed to summarize current evidence and quantitatively evaluate the effect of frailty on postoperative outcomes in geriatric patients receiving surgery for CRC.…”

Section: Introductionmentioning

confidence: 99%

Does frailty predict postoperative outcomes in geriatric patients receiving surgery for colorectal cancer? A systematic review and meta-analysis

Yang¹,

Xu²,

Cao³

et al. 2020

Preprint

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Background Surgery remains the mainstay of colorectal cancer (CRC) and substantially reduces cancer-related morbidity and mortality. Preoperative assessment for frailty in geriatric patients is critically important in risk stratification and clinical decision-making. In this systematic review and meta-analysis, we aimed to quantitatively summarise the effect of frailty on postoperative outcomes in geriatric patients receiving surgery for CRC. Methods A systematic literature search was conducted in MEDLINE, Cochrane and EMBASE from inception to 30 April 2020. Fully published articles reporting risk estimate(s) of frailty on postoperative complication(s), readmission and/ or mortality in patients aged ≥65 years who received surgery for CRC were eligible for qualitative and quantitative analyses. Results Across 10 articles of 9 unique studies (n = 69332) that were eventually included in the systematic review and meta-analysis, overall prevalence of frailty was 23.0% (95% CI: 11–43%, I 2 = 100%). Odds ratios (ORs) on overall and severe postoperative complications were respectively increased by 2.36- (95% CI: 1.66–3.35, P <0.01; I 2 = 12%) and 2.35-fold (95% CI: 1.30–4.27, P <0.01; I 2 = 72%) in frail patients compared to non-frail counterparts. On pooled analysis, frailty was significantly associated with an increased risk of postoperative readmission (OR:1.91; 95% CI: 1.35–2.70, P <0.01; I 2 = 6%). Whilst a significantly higher risk of frailty on mortality during 12 months after CRC surgery was observed (OR: 5.52; 95% CI:4.40–6.92, P <0.01; I 2 = 89%), the summary OR on 30-day/ inpatient mortality crossed the null line (OR: 1.65; 95% CI: 0.56–4.93, P = 0.37; I 2 = 55%). Funnel plot and Duval-Tweedie’s trim and fill test did not reveal significant publication bias. Conclusions In the studies reviewed, frailty appeared to be associated with increased risks for postoperative complications, readmission and mortality during 12 months in patients aged ≥65 years who received surgery for CRC. Nevertheless, no significant association between frailty and 30-day/ inpatient postoperative mortality was observed.

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The association between performance parameters of physical fitness and postoperative outcomes in patients undergoing colorectal surgery: An evaluation of care data

Abstract: There is an association between preoperative parameters and postoperative outcomes in patients with colorectal cancer scheduled for resection. Patients benefit from an optimal preoperative physical fitness level. Specific interventions can target this physical fitness level.

Cited by 29 publications

References 31 publications

Preoperative handgrip strength is not associated with complications and health-related quality of life after surgery for colorectal cancer

Preoperative handgrip strength is not associated with complications and health-related quality of life after surgery for colorectal cancer

Personalized community-based prehabilitation for a high-risk surgical patient opting for pylorus-preserving pancreaticoduodenectomy: a case report

Does frailty predict postoperative outcomes in geriatric patients receiving surgery for colorectal cancer? A systematic review and meta-analysis

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