eP455 - Prehabilitation and Improved Colorectal-Specific Surgical Outcomes in Older Adults

Sunday, June 2, 2024

2:15 PM – 2:20 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Lindsey Zhang, MD

Fellow
Washington University School of Medicine
St Louis, MO, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

JZ

Jorge Zarate Rodriguez, MD

Resident physician
Washington University School of Medicine in St Louis
St Louis, Missouri, United States

Disclosure information not submitted.
HN

Harika Nalluri-Butz, MD

Colorectal Surgery Fellow
Washington University in St Louis
St Louis, Missouri, United States

Disclosure information not submitted.
AD

Austin Richard Dosch, MD PhD

Fellow
Washington University School of Medicine
St Louis, Missouri, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Kerri A. Ohman, MD, FACS (she/her/hers)

Assistant Professor
Washington University School of Medicine
Saint Louis, MO, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
PW

Paul Wise, MD FACS

Professor of Surgery
Washington University School of Medicine
St Louis, Missouri, United States

Disclosure information not submitted.
Steven Hunt, MD

Professor of Surgery
Washington University School of Medicine
St Louis, Missouri, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
MS

Matthew Silviera, MD MS

Assistant Professor of Surgery
Washington University School of Medicine
St Louis, Missouri, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no relevant relationships with ineligible companies.
Matthew Mutch, MD, FACS, FASCRS

Professor of Surgery
Washington University School of Medicine
Washington University School of Medicine
St Louis, Missouri, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
DS

Dominic Sanford, MD, MPHS, FACS

Assistant Professor
Washington University in St. Louis
St. Louis, Missouri, United States

Disclosure information not submitted.

Senior Author(s)

WC

William Chapman, Jr, MD

Assistant Professor
Washington University in St. Louis
St. Louis, Missouri, United States

Disclosure information not submitted.

Purpose/Background: Prehabilitation programs have come to the forefront of many quality improvement efforts aimed at improving surgical outcomes among a rapidly aging surgical population. Recent data has shown prehabilitation associated with reductions in length of stay and 30-day mortality. However, the impact of prehabilitation on postoperative complications such as anastomotic leak and ileus has not been investigated among aged colorectal surgical cohorts. This study aims to evaluate the association of prehabilitation with colorectal-specific outcomes.Methods/Interventions: Utilizing data from a comprehensive surgical prehabilitation program at a single, tertiary medical center, we identified patients 60 years or older who were referred to prehabilitation by the colorectal surgery department. These patients were propensity score matched to non-prehabilitation patients identified from an institutional ACS NSQIP colectomy and proctectomy procedure targeted database in 1:3 fashion based on inverse probability of treatment weighting. Patient and procedure characteristics were used to create the match. The primary outcome of the study was incidence of anastomotic leak and ileus.Results/Outcomes: From July 2021 to September 2023, 48 patients were identified who participated in prehabilitation prior to their colorectal operation. There was a 2.1% leak rate and 27% of patients developed an ileus. Initial analysis between prehabing patients and their propensity score matched cohort (n=802) did not show a statistical difference in rates of anastomotic leak and ileus. However, after exclusion of patients who participated for < 30 days, there was a statistically significant decrease in the odds of anastomotic leak in prehabilitation participants compared to matched counterparts (OR 0.97, 95% CI 0.96-0.99).Conclusion/

Discussion: These results demonstrate that prehabilitation programs are associated with a decrease in some colorectal specific complications, such as anastomotic leak, in older adult patients undergoing surgery. Importantly, patients who participated in less than one month of the program did not have any significant improvement in outcomes. This suggests that for elective procedures, extended prehabilitation time may be of benefit. This strategy may not be feasible for colon adenocarcinoma where upfront surgical resection remains standard of care for most stages. However, with the rapid adoption of total neoadjuvant therapy for rectal adenocarcinoma, the prolonged time prior to surgery may serve as a unique opportunity for prehabilitation in older adult patients at risk.