QS305 - Prehabilitation Improves Postoperative Outcomes in Colorectal Patients Even With Shorter Enrollment Times

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Purpose/Background: Prehabilitation has emerged as an important tool for optimizing the functional status of high-risk patients prior to surgery. Previous data from an institution-specific prehabilitation program showed improvements in 30-day mortality and need for discharge to post-acute care facilities (PACF) across an entire surgical department when compared to historical control patients from the institution’s NSQIP database. Colorectal patients have variable wait times before surgery, with shorter wait times recommended for colon cancer patients. However, there is limited research examining the effect of prehabilitation duration on postoperative outcomes. We hypothesized that a minimal enrollment time of at least 30 days would be necessary to observe improvements in postoperative outcomes.

Methods/Interventions: A prospectively maintained database of patients enrolled in the Surgical Prehabilitation and Readiness (SPAR) program was analyzed for preoperative and postoperative parameters, including demographics, comorbidities, surgical and pathology findings, and postoperative outcomes. Patients were divided into two sub-groups: those enrolled in SPAR for 30 days or less, and those enrolled for greater than 30 days. Postoperative outcomes were compared between the short enrollment group and the rest of the cohort, as well as against expected NSQIP outcomes. The primary outcomes included 30-day mortality, 30-day readmission, need for discharge to PACF, and postoperative length-of-stay (PLOS).

Results/Outcomes: Over two years, 102 patients were enrolled in SPAR, underwent colorectal surgery, and had at least 30 days of postoperative follow-up. The median age was 69.8 years, and 85.3% of patients had an ASA class of 3 or higher. The median enrollment time was 43 days. Twenty-eight patients had an enrollment duration of 30 days or less. No significant differences in demographics or comorbidities were found between the short enrollment group and the rest of the cohort. The most common indications for surgery in the short enrollment group were colon cancer (n=12, 42.86%) and high-risk adenoma or unresectable polyp (n=5, 17.86%). In the remaining cohort, the most common indications were diverticulitis (n=18, 24.32%), colon cancer (n=17, 22.97%), and rectal cancer (n=11, 14.86%). Patients with shorter SPAR enrollment times showed improvements in 30-day mortality (0.00% vs. 1.97%, p< 0.001) and discharge to PACF (3.85% vs. 10.95%, p< 0.001) compared to their expected NSQIP outcomes, with no significant differences in outcomes between this group and the remainder of the cohort.

Conclusion/Discussion: Prehabilitation improved postoperative outcomes even for patients enrolled for less than 30 days, with no significant differences compared to the rest of the cohort. These findings suggest that patients can benefit from prehabilitation even with a short waiting period before scheduled surgery, which may be especially relevant in the management of colon cancer.