The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Compa
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ORIGINAL ARTICLE
The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison Laura J. Halliday 1
&
Emre Doganay 1 & Venetia A. Wynter-Blyth 2 & George B. Hanna 1 & Krishna Moorthy 1
Received: 5 August 2020 / Accepted: 10 November 2020 # 2020 The Author(s)
Abstract Background Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive. Methods Between January 2016 and April 2019, all patients with resectable oesophageal cancer who underwent curative treatment at a specialist tertiary centre participated in a personalised, home-based, multimodal prehabilitation programme. Post-operative complications and hospital stay in this group were compared to a control sample. Propensity score matching was used to control for differences in baseline characteristics. Results Seventy-two patients who completed prehabilitation and 39 control patients were studied; following propensity score matching, there were 38 subjects in each group. In comparison to matched controls, patients in the prehabilitation group had a lower incidence of post-operative pneumonia (prehabilitation = 26%; control = 66%; p = 0.001) and a shorter length of stay (prehabilitation = median 10 days, IQR 8–17 days; control = median 13 days, IQR 11–20 days; p = 0.018). On multivariate regression analysis, participation in prehabilitation was associated with a 77% lower incidence of post-operative pneumonia (OR 0.23, 95% CI 0.09 to 0.55 p = 0.001). There was no significant difference in the incidence of overall complications or severe complications. Conclusion Prehabilitation was associated with a lower incidence of post-operative pneumonia and shorter hospital length of stay following oesophagectomy. This model of home based, personalised, and supervised prehabilitation is effective and relevant to centralised cancer services. Keywords Oesophageal cancer . Exercise therapy . Preoperative care . Surgery
Introduction Patients undergoing oesophageal cancer surgery are often elderly, frail, malnourished, with poor functional reserve, all of which are associated with poor postoperative outcomes.1–4 Up to 60% of patients experience post-operative complications.5
* Laura J. Halliday [email protected] 1
Department of Surgery and Cancer, Imperial College London, London, UK
2
Oesophago-gastric cancer surgery unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
The high morbidity can lead to a prolonged hospital stay, delayed recovery, long-term disability, and poor survival.6–8. Prehabilitation utilises the time before surgery to improve a patient’s functional capacity to better withstand the stress of surgery.9,10 Through activation of inflammatory, endocrine, and immunological responses, the ‘surgical stress response’ creates increased metabolic d
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