Chan KS, Ng P, Tan L, Soh REJ, Tan BT, Ong YJ, Chong JL, Mantoo SK, Lee YZ, Tan KY, Lee DJK. Postoperative outcomes following prehabilitation vs no prehabilitation in elective colorectal surgery: A 2:1 propensity score-matched analysis. World J Gastrointest Surg 2025; 17(11): 108345 [DOI: 10.4240/wjgs.v17.i11.108345]
Corresponding Author of This Article
Kai Siang Chan, Researcher, Department of General Surgery, Khoo Teck Puat Hospital, No. 90 Yishun Central, Singapore 768828, Singapore. kchan023@e.ntu.edu.sg
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 27, 2025 (publication date) through Nov 25, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Chan KS, Ng P, Tan L, Soh REJ, Tan BT, Ong YJ, Chong JL, Mantoo SK, Lee YZ, Tan KY, Lee DJK. Postoperative outcomes following prehabilitation vs no prehabilitation in elective colorectal surgery: A 2:1 propensity score-matched analysis. World J Gastrointest Surg 2025; 17(11): 108345 [DOI: 10.4240/wjgs.v17.i11.108345]
World J Gastrointest Surg. Nov 27, 2025; 17(11): 108345 Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.108345
Postoperative outcomes following prehabilitation vs no prehabilitation in elective colorectal surgery: A 2:1 propensity score-matched analysis
Kai Siang Chan, Priscilla Ng, Lynn Tan, Rachel E-Jing Soh, Boon Theng Tan, Yu Jing Ong, Joon Lan Chong, Surendra Kumar Mantoo, Yao Zong Lee, Kok-Yang Tan, Daniel Jin Keat Lee
Kai Siang Chan, Surendra Kumar Mantoo, Yao Zong Lee, Kok-Yang Tan, Daniel Jin Keat Lee, Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Priscilla Ng, Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Co-corresponding authors: Kai Siang Chan and Daniel Jin Keat Lee.
Author contributions: Chan KS contributed to analysis and interpretation of data, drafting the manuscript, and revising the manuscript; Ng P contributed to analysis and interpretation of data; Ng P, Tan KY, and Lee DJK contributed to conceptualization and supervision; Tan L, Soh REJ, Tan BT, Ong YJ, Chong JL, Mantoo SK, Lee YZ, Tan KY, and Lee DJK contributed to acquisition of data; Lee DJK contributed to revising the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of National Healthcare Group Domain Specific (Approval No. 2021/00967).
Informed consent statement: The requirement for informed consent was waived as the study was retrospective in nature and utilized a prospectively maintained database without the use of personally identifiable patient information.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used in this study is not publicly available due to institutional policies. However, requests may be made to the corresponding author for access to de-identified data.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai Siang Chan, Researcher, Department of General Surgery, Khoo Teck Puat Hospital, No. 90 Yishun Central, Singapore 768828, Singapore. kchan023@e.ntu.edu.sg
Received: April 14, 2025 Revised: June 20, 2025 Accepted: September 19, 2025 Published online: November 27, 2025 Processing time: 227 Days and 14.1 Hours
Abstract
BACKGROUND
Aging is associated with reduced physiological reserves, frailty, sarcopenia, and increases in other comorbidities. Existing studies on prehabilitation showed potential in improving postoperative outcomes but were heterogeneous. Recommendations are still weak for promoting multimodal prehabilitation before elective colorectal surgery. There is also no recommendation on the best criteria to select patients for prehabilitation.
AIM
To compare postoperative outcomes in patients with prehabilitation vs those without prior to elective colorectal surgery using propensity score matching (PSM).
METHODS
This retrospective study was conducted from July 2010 to December 2021 on patients aged ≥ 75 years, or aged ≥ 65 years and frail, and/or had Charlson comorbidity index ≥ 4 who underwent elective colorectal surgery. Perioperative care included a specialized nurse, physiotherapist, dietician, and geriatrician review. Decision for the type of prehabilitation (inpatient, outpatient, or home-based) was made after a joint discussion considering patient’s mobility, caregiver availability, and anticipated compliance to physiotherapy regime. A 2:1 PSM was performed to balance.
RESULTS
There were 208 patients (prehabilitation: 148, no prehabilitation: 60) in the unmatched cohort. There were 43.8% who were aged ≥ 80 years, 31.7% who were frail, and 43.8% who underwent laparoscopic surgery. Duration of prehabilitation ranged from 2-4 weeks. The overall incidence of major morbidity, 30-day mortality, and 1-year mortality were 12.0%, 1.9%, and 6.7%, respectively. The PSM group had 144 patients. Prehabilitation was not an independent predictor of major morbidity [odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.30-2.33] and 1-year mortality (OR = 1.26, 95%CI: 0.30-5.28). Subgroup analysis of patients who were not frail (prehabilitation n = 79, no prehabilitation n = 40) similarly showed that prehabilitation was not an independent predictor of major morbidity (OR = 0.75, 95%CI: 0.26-2.14) and 1-year mortality (OR = 1.04, 95%CI: 0.24-4.55).
CONCLUSION
Older patients who were not frail did not benefit from prehabilitation. Selection criteria for prehabilitation may be modified to target patients who will better benefit from it.
Core Tip: Aging is associated with frailty, increased comorbidities, and worse postoperative outcomes. Some studies on prehabilitation showed its potential in improving postoperative outcomes for elective colorectal surgery, but selection criteria and prehabilitation protocols are heterogeneous. Through propensity score matching, this study showed that prehabilitation in non-frail older patients (≥ 65 years) did not improve short-term outcomes and 1-year mortality. Open surgery was an independent predictor of 1-year mortality. Consideration should be made to modify and stratify the selection criteria for prehabilitation based on frailty scores and comorbidity burden to identify the group of patients who will best benefit given finite resources.
