Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity : results of a single-center, single-blinded, randomized controlled trial

Gloor, S.; Misirlic, M.; Frei-Lanter, C.; Herzog, P.; Müller, P.; Schäfli-Thurnherr, J.; Schregel, D.; Lamdark, T.; Wyss, R.; Unger, I.; Gisi, D.; Greco, N.; Mungo, G.; Wirz, M.; Raptis, D.A.; Tschuor, C.; Breitenstein, S.

doi:10.1093/bjs/znab202.015

Publication type:	Conference other
Type of review:	Peer review (abstract)
Title:	Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity : results of a single-center, single-blinded, randomized controlled trial
Authors:	Gloor, S. Misirlic, M. Frei-Lanter, C. Herzog, P. Müller, P. Schäfli-Thurnherr, J. Schregel, D. Lamdark, T. Wyss, R. Unger, I. Gisi, D. Greco, N. Mungo, G. Wirz, M. Raptis, D.A. Tschuor, C. Breitenstein, S.
et. al:	No
DOI:	10.1093/bjs/znab202.015
Published in:	British Journal of Surgery
Proceedings:	Abstracts of the 108th Annual Swiss Congress of Surgery held as a virtual meeting 1-3 June 2021
Volume(Issue):	108
Issue:	Supplement 4
Conference details:	108th Annual Swiss Congress of Surgery, virtual, 1-3 June 2021
Issue Date:	May-2021
Publisher / Ed. Institution:	Oxford University Press
ISSN:	0007-1323 1365-2168
Language:	English
Subjects:	Physical activity; Physiotherapy; Colorectal surgery; Preoperative care
Subject (DDC):	615.82: Physical therapy 617: Surgery
Abstract:	Objective: Patients undergoing major surgery are prone to a functional decline due to the impairment of muscle, cardiorespiratory and neurological function as a response to surgical stress. Currently, there are solely weak recommendations in the ERAS protocol regarding the role of preoperative physical activity and prehabilitation in patients undergoing colorectal surgery. Studies in heterogenous cohorts showed contradictory results regarding the impact of prehabilitation on the reduction of postoperative complications. This randomized controlled trial assesses the impact of prehabilitation on postoperative complications in patients undergoing colorectal surgery within an ERAS protocol. Methods: Between July 2016 and June 2019, a single-center, single-blinded , randomized controlled trial designed to test whether physiotherapeutic prehabilitation vs. normal physical activities prior to colorectal surgery may decrease morbidity within a stringent ERAS protocol was carried out. The primary endpoint was postoperative complications assessed by Comprehensive Complications Index (CCI®). Primary and secondary endpoints for both groups were analyzed and compared. Results: A total of 107 patients (54 in the pERACS and 53 in the control cohort) were included in the study and randomized. Dropout rate was 4.5% (n = 5). Mean age (SD) in the control cohort was 65 (29–86) and 66 (24–90) years in pERACS cohort. The pERACS cohort contained more female patients (40% vs. 55%, p = 0.123) and a higher percentage of colorectal adenocarcinoma (32% vs. 23%, p = 0.384) although not significant. Almost all patients underwent minimally invasive surgery in both cohorts (96% vs 98%, p = 1.000). There was no between-cohort difference in the primary outcome measure 30-day Comprehensive Complications Index (15 [0 – 49] vs. 18 [0 – 43], p = 0.059). Secondary outcome as complications assessed according to Clavien-Dindo, length of hospital stay, reoperation rate and mortality showed no difference between both cohorts. Conclusion: Routine physiotherapeutic prehabilitation cannot be recommended for patients undergoing colorectal surgery within an ERAS protocol (Grade A recommendation). To eliminate other confounders like geographical difference or difference in surgical technique, further multicenter RCTs are needed.
URI:	https://academic.oup.com/bjs/article/108/Supplement_4/znab202.015/6287411 https://digitalcollection.zhaw.ch/handle/11475/24270
Fulltext version:	Published version
License (according to publishing contract):	Licence according to publishing contract
Departement:	School of Health Sciences
Organisational Unit:	Institute of Physiotherapy (IPT)
Published as part of the ZHAW project:	Präoperative Physiotherapie bei kolorektalen Eingriffen
Appears in collections:	Publikationen Gesundheit

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Gloor, S., Misirlic, M., Frei-Lanter, C., Herzog, P., Müller, P., Schäfli-Thurnherr, J., Schregel, D., Lamdark, T., Wyss, R., Unger, I., Gisi, D., Greco, N., Mungo, G., Wirz, M., Raptis, D. A., Tschuor, C., & Breitenstein, S. (2021). Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity : results of a single-center, single-blinded, randomized controlled trial [Conference presentation]. British Journal of Surgery, 108(Supplement 4). https://doi.org/10.1093/bjs/znab202.015

Gloor, S. et al. (2021) ‘Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity : results of a single-center, single-blinded, randomized controlled trial’, in British Journal of Surgery. Oxford University Press. Available at: https://doi.org/10.1093/bjs/znab202.015.

S. Gloor et al., “Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity : results of a single-center, single-blinded, randomized controlled trial,” in British Journal of Surgery, May 2021, vol. 108, no. Supplement 4. doi: 10.1093/bjs/znab202.015.

GLOOR, S., M. MISIRLIC, C. FREI-LANTER, P. HERZOG, P. MÜLLER, J. SCHÄFLI-THURNHERR, D. SCHREGEL, T. LAMDARK, R. WYSS, I. UNGER, D. GISI, N. GRECO, G. MUNGO, M. WIRZ, D.A. RAPTIS, C. TSCHUOR und S. BREITENSTEIN, 2021. Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity : results of a single-center, single-blinded, randomized controlled trial. In: British Journal of Surgery [online]. Conference presentation. Oxford University Press. Mai 2021. Verfügbar unter: https://academic.oup.com/bjs/article/108/Supplement_4/znab202.015/6287411

Gloor, S., M. Misirlic, C. Frei-Lanter, P. Herzog, P. Müller, J. Schäfli-Thurnherr, D. Schregel, et al. 2021. “Prehabilitation in Patients Undergoing Colorectal Surgery Fails to Confer Reduction in Overall Morbidity : Results of a Single-Center, Single-Blinded, Randomized Controlled Trial.” Conference presentation. In British Journal of Surgery. Vol. 108. Oxford University Press. https://doi.org/10.1093/bjs/znab202.015.

Gloor, S., et al. “Prehabilitation in Patients Undergoing Colorectal Surgery Fails to Confer Reduction in Overall Morbidity : Results of a Single-Center, Single-Blinded, Randomized Controlled Trial.” British Journal of Surgery, vol. 108, no. Supplement 4, Oxford University Press, 2021, https://doi.org/10.1093/bjs/znab202.015.