Postoperative outcomes following prehabilitation vs no prehabilitation in elective colorectal surgery: A 2:1 propensity score-matched analysis.

BACKGROUND: Aging is associated with reduced physiological reserves, frailty, sarcopenia, and increases in other comorbidities. Existing studies on prehabilitation showed potential in improving postoperative outcomes but were heterogeneous. Recommendations are still weak for promoting multimodal prehabilitation before elective colorectal surgery. There is also no recommendation on the best criteria to select patients for prehabilitation. AIM: To compare postoperative outcomes in patients with prehabilitation vs those without prior to elective colorectal surgery using propensity score matching (PSM). METHODS: This retrospective study was conducted from July 2010 to December 2021 on patients aged ≥ 75 years, or aged ≥ 65 years and frail, and/or had Charlson comorbidity index ≥ 4 who underwent elective colorectal surgery. Perioperative care included a specialized nurse, physiotherapist, dietician, and geriatrician review. Decision for the type of prehabilitation (inpatient, outpatient, or home-based) was made after a joint discussion considering patient's mobility, caregiver availability, and anticipated compliance to physiotherapy regime. A 2:1 PSM was performed to balance. RESULTS: There were 208 patients (prehabilitation: 148, no prehabilitation: 60) in the unmatched cohort. There were 43.8% who were aged ≥ 80 years, 31.7% who were frail, and 43.8% who underwent laparoscopic surgery. Duration of prehabilitation ranged from 2-4 weeks. The overall incidence of major morbidity, 30-day mortality, and 1-year mortality were 12.0%, 1.9%, and 6.7%, respectively. The PSM group had 144 patients. Prehabilitation was not an independent predictor of major morbidity [odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.30-2.33] and 1-year mortality (OR = 1.26, 95%CI: 0.30-5.28). Subgroup analysis of patients who were not frail (prehabilitation n = 79, no prehabilitation n = 40) similarly showed that prehabilitation was not an independent predictor of major morbidity (OR = 0.75, 95%CI: 0.26-2.14) and 1-year mortality (OR = 1.04, 95%CI: 0.24-4.55). CONCLUSION: Older patients who were not frail did not benefit from prehabilitation. Selection criteria for prehabilitation may be modified to target patients who will better benefit from it.