Currently, there are solely weak recommendations in the enhanced recovery after surgery (ERAS) protocol regarding the role of preoperative physical activity and prehabilitation in patients undergoing colorectal surgery. Studies in heterogenous groups showed contradictory results regarding the impact of prehabilitation on the reduction of postoperative complications. The aim of this study was to assess the impact of prehabilitation on postoperative complications in patients undergoing colorectal surgery within an ERAS protocol.
Between July 2016 and June 2019, a single-center, 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.
A total of 107 patients (54 in the prehabilitation enhanced recovery after colorectal surgery [pERACS] group and 53 in the control group) were included in the study and randomized. Dropout rate was 4.5% (n = 5). Baseline characteristics were comparable between the pERACS and control groups. The percentage of colorectal adenocarcinoma was low in both groups (pERACS 32% vs. control 23%, p = 0.384). Almost all patients underwent minimally invasive surgery in both groups (96% vs. 98%, p = 1.000). There was no between-group difference in the primary outcome, as the mean CCI at 30-day postoperative in the pERACS group was 18 (SD 0–43) compared to 15 (SD 0–49) in the control group (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 groups.
Routine physiotherapeutic prehabilitation has no additional benefit for patients undergoing colorectal surgery within an ERAS protocol.
ClinicalTrial.gov: ID: NCT02746731; Institution Ethical Board Approval: KEK-ZH Nr. 2016–00,229.
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American Society of Anesthesiologists
Comprehensive Complication Index®
Enhanced recovery after surgery
Intensive care unit
Length of stay
New York heart association classification
Prehabilitation enhanced recovery after colorectal surgery
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The authors wish to thank the study nurses, especially Brigitte Gasser and team, for their excellent support in performing this trial. Further, we would like to thank Cornelia Merki-Künzli MD, for creating the study protocol and the team of the physiotherapy with Marta Kerstan and Michaela Hagen for managing the secuTrial! software on physiotherapeutic side. We would also like to thank Felix Grieder MD, Michel Adamina MD, Hans Gelpke MD, Christian Gingert MD, Georgios Peros MD, Sina Schmidt MD, and Christopher Soll MD who helped with acquisition of patients.
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Gloor, S., Misirlic, M., Frei-Lanter, C. et al. Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity: results of a single-center, blinded, randomized controlled trial. Langenbecks Arch Surg 407, 897–907 (2022). https://doi.org/10.1007/s00423-022-02449-0