Preoperative Functional Status Is Not Associated With Postoperative Surgical Complications in Low Risk Patients Undergoing Esophagectomy

van Egmond M.A.1,2, van der Schaaf M.1,2, Klinkenbijl J.H.G.3,4, van Berge Henegouwen M.I.5, Engelbert R.H.H.1,21Academic Medical Center, University of Amsterdam, Rehabilitation, Amsterdam, Netherlands, 2Amsterdam University of Applied Sciences, Physiotherapy, Amsterdam, Netherlands, 3Gelre Hospital, Surgery, Apeldoorn, Netherlands, 4University of Amsterdam, Amsterdam, Netherlands, 5Academic Medical Center, University of Amsterdam, Surgery, Amsterdam, NetherlandsBackground: Preoperative functional status is a risk factor for developing postoperative complications (POC) in major abdominal and thoracic surgery, but this has hardly been evaluated in patients with esophageal cancer undergoing esophagectomy. In order to determine which patients are at risk for developing postoperative complications and a delayed functional recovery, preoperative functional status needs to be assessed. Based on this, patients could be identified who might benefit from a tailored pre-or postoperative physiotherapeutic intervention.Purpose: To determine if preoperative functional status in patients with esophageal cancer undergoing esophagectomy is associated with POC.Methods: From March 2012 to October 2014, patients with esophageal cancer scheduled for esophagectomy at the outpatient clinic of a large tertiary referral center were eligible for the study. We measured inspiratory muscle strength, hand grip strength, physical activities, and health related quality of life as indicators of functional status one day before surgery. POC were scored according to the Clavien-Dindo Classification. We used univariate and multivariate backward regression analysis to determine the association between functional status and POC.Results: We included 94 patients in the study and esophagectomy was performed in 90 patients from which 55 developed POC (61.1%). After multivariate analysis, none of the indicators of preoperative functional status were independently associated with POC (inspiratory muscle strength OR 1.00; P50.779, hand grip strength OR 0.99; P50.250, physical activities OR 1.00; P50.174, and health related quality of life OR 1.02; P50.222).Conclusion(s): From our study, we conclude that despite the high rate of POC, preoperative functional status in our cohort of patients treated with esophagectomy does not predict POC. Therefore, preoperative functional status should not always be considered as a risk factor for POC in high-risk surgical populations per se.Implications: Based on the outcomes of our study, we emphasize the need to carefully assess the association between preoperative functional status and POC and relate this to patient- and surgery specific characteristics, before indicating a preoperative physiotherapy intervention to all patients undergoing surgery. Instead, risk stratification should be applied to only identify patients with a low initial preoperative functional status or other risk factors for a poor postoperative recovery who might benefit from a preoperative physiotherapy intervention. A standardized risk stratification may ultimately contribute to the efficient use of a physiotherapeutic intervention by only indicating patients with a high risk of delayed recovery.Funding acknowledgements: The first author received a Doctoral Grant for Teachers in 2014 from the Netherlands Association for Scientific Research (NWO)Topic: Oncology, HIV & palliative careEthics approval: The medical ethics committee of the Academic Medical Center Amsterdam waived the need for informed consent.All authors, affiliations and abstracts have been published as submitted.