Key result
Improved preoperative 6MWT distance is linked to a ~72% lower risk of severe 30-day complications.
Why the study?
Poor functional capacity predicts postoperative morbidity, but evidence is lacking on whether enhancing functional capacity before surgery protects against postoperative complications.
Does improved preoperative functional capacity reduce 30-day postoperative complications in adults undergoing colorectal resection for cancer?
Cohort (n=179)
Does improved preoperative functional capacity reduce 30-day postoperative complications in adults undergoing colorectal resection for cancer?
Odds Ratio: 0.28 (95% CI 0.11–0.74)
p-value: p=0.010
Improving functional capacity before colorectal cancer surgery is associated with a significantly lower risk of severe postoperative complications.
Improved preoperative FC was associated with fewer severe complications after colorectal cancer resection; leaves open whether targeted prehabilitation reduces morbidity in RCTs.
Background: Poor functional capacity (FC) is an independent predictor of postoperative morbidity. However, there is still a lack of evidence as to whether enhancing FC before surgery has a protective effect on postoperative complications. The purpose of this study was to determine whether an improvement in preoperative FC impacted positively on surgical morbidity.Methods: This was a secondary analysis of a cohort of patients who underwent colorectal resection for cancer under Enhanced Recovery After Surgery care. FC was assessed with the 6-min walk test, which measures the distance walked in 6 min (6MWD), at 4 weeks before surgery and again the day before. The study population was classified into two groups depending on whether participants achieved a significant improvement in FC preoperatively (defined as a preoperative 6MWD change ≥19 meters) or not (6MWD change <19 meters). The primary outcome measure was 30-d postoperative complications, assessed with the Comprehensive Complication Index (CCI). The association between improved preoperative FC and severe postoperative complication was evaluated using multivariable logistic regression.Results: A total of 179 eligible adults were studied: 80 (44.7%) improved in 6MWD by ≥19 m preoperatively, and 99 (55.3%) did not. Subjects whose FC increased had lower CCI (0 [0–8.7] versus 8.7 [0–22.6], p = .022). Furthermore, they were less likely to have a severe complication (adjusted OR 0.28 (95% CI 0.11–0.74), p = .010), and to have an ED visit.Conclusion: Improved preoperative FC was independently associated with a lower risk of severe postoperative complications. Further investigation is required to establish a causative relationship conclusively.
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Minnella et al. (2019) conducted a cohort in Colorectal cancer (n=179). Preoperative functional capacity improvement (6MWD change ≥19 meters) vs. No significant improvement in functional capacity (6MWD change <19 meters) was evaluated on 30-day postoperative complications (assessed with the Comprehensive Complication Index) and severe postoperative complications (adjusted OR 0.28, 95% CI 0.11-0.74, p=0.010). Preoperative functional capacity improvement (≥19m on 6-minute walk test) was associated with a lower risk of severe 30-day postoperative complications (adjusted OR 0.28; 95% CI 0.11-0.74; p=0.010).
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