Postoperative outcomes following prehabilitation vs no prehabilitation in elective colorectal surgery: A 2:1 propensity score-matched analysis

Table 1 Clinical demographics of patients who underwent elective major colorectal surgery in those with and without prehabilitation

	Overall group, n = 208					PSM group, n = 144
	Total	Prehabilitation (n = 148)	No prehabilitation (n = 60)	P value	SMD	Total	Prehabilitation (n = 96)	No prehabilitation (n = 48)	P value	SMD
Age, years1	79.0 (76.0-82.0)	79.0 (76.0-82.0)	79.0 (75.3-81.0)	0.371	0.167	78.0 (75.0-82.0)	78.0 (75.0-82.0)	79.0 (76.0-82.0)	0.603	0.076
Age ≥ 80 years	91 (43.8)	66 (44.6)	25 (41.7)	0.700	N/A	57 (39.6)	36 (37.5)	21 (43.8)	0.470	N/A
Sex, male1	103 (49.5)	70 (47.3)	33 (55.0)	0.314	0.154	73 (50.7)	49 (51.0)	24 (50.0)	0.906	0.021
ASA score	3.0 (2.0-3.0)	3.0 (2.0-3.0)	3.0 (2.0-3.0)	0.091	N/A	3.0 (2.0-3.0)	3.0 (2.0-3.0)	3.0 (2.0-3.0)	0.410	N/A
≥ 31	131 (63.0)	98 (66.2)	33 (55.0)	0.129	0.230	80 (55.6)	55 (57.3)	25 (52.1)	0.553	0.104
CCI	4.0 (2.3-6.0)	4.0 (3.0-6.0)	3.0 (2.0-5.0)	0.004a	N/A	3.0 (2.0-6.0)	3.0 (2.0-6.0)	3.0 (2.0-5.0)	0.153	N/A
≥ 41	116 (55.8)	89 (60.1)	27 (45.0)	0.046a	0.305	68 (47.2)	46 (47.9)	22 (45.8)	0.813	0.042
Predicted mortality					N/A					N/A
P-POSSUM, %	6.9 (4.0-10.6)	6.8 (4.2-10.7)	7.0 (3.7-10.5)	0.465	N/A	6.2 (3.4-10.3)	6.2 (3.4-10.1)	7.0 (3.5-10.8)	0.879	N/A
P-POSSUM > 5%1	140 (67.3)	102 (68.9)	38 (63.3)	0.437	N/A	93 (64.6)	62 (64.6)	31 (64.6)	1.000	N/A
Predicted morbidity, %	41.8 (30.4-53.0)	42.6 (31.0-54.5)	39.8 (29.3-51.0)	0.199	N/A	39.0 (29.3-50.9)	38.3 (28.9-50.9)	39.8 (29.3-51.0)	0.909	N/A
Modified Barthel index1	100 (98-100)	100 (98-100)	100 (100-100)	0.009a	0.174	100 (100-100)	100 (100-100)	100 (100-100)	0.572	0.019
Premorbid status				0.014a	N/A				0.354	N/A
Community ambulant	183 (88.0)	125 (84.5)	58 (96.7)		N/A	134 (93.1)	88 (91.7)	46 (95.8)		N/A
Home bound	25 (12.0)	23 (15.5)	2 (3.3)		N/A	10 (6.9)	8 (8.3)	2 (4.2)		N/A
Bed bound	0	0	0		N/A	0	0	0		N/A
Frail, yes1	66 (31.7)	57 (38.5)	9 (15.0)	< 0.001a	0.548	25 (17.4)	17 (17.7)	8 (16.7)	0.876	0.027
Tumor stage				0.618	N/A				0.365	N/A
0	18 (8.7)	14 (9.5)	4 (6.7)		N/A	12 (8.3)	10 (10.4)	2 (4.2)		N/A
1	25 (12.0)	18 (12.2)	7 (11.7)		N/A	19 (13.2)	12 (12.5)	7 (14.6)		N/A
2	77 (37.0)	51 (34.5)	26 (43.3)		N/A	51 (35.4)	30 (31.3)	21 (43.8)		N/A
3	85 (40.9)	62 (41.9)	23 (38.3)		N/A	60 (41.7)	42 (43.8)	18 (37.5)		N/A
4	3 (1.4)	3 (2.0)	0 (0)		N/A	2 (1.4)	2 (2.1)	0 (0)		N/A
Tumor stage ≥ 3, yes	88 (42.3)	65 (43.9)	23 (38.3)	0.460	N/A	62 (43.1)	44 (45.8)	18 (37.5)	0.341	N/A
Tumor site				0.377	N/A				0.743	N/A
Colon	177 (85.1)	128 (86.5)	49 (81.7)		N/A	122 (84.7)	82 (85.4)	40 (83.3)		N/A
Rectum	31 (14.9)	20 (13.5)	11 (18.3)		N/A	22 (15.3)	14 (14.6)	8 (16.7)		N/A
Surgical access1				0.076	0.271				0.479	0.125
Open	117 (56.3)	89 (60.1)	28 (46.7)		N/A	75 (52.1)	48 (50.0)	21 (43.8)		N/A
Laparoscopic	91 (43.8)	59 (39.9)	32 (53.3)		N/A	59 (47.9)	48 (50.0)	21 (43.8)		N/A

¹Propensity score matching was performed for these variables due to potential and/or significant effects on clinical outcomes or due to significant differences in demographics between the two study groups.

^aP < 0.05.

Data are presented as median (interquartile range) or n (%). ASA: American Society of Anesthesiologists; CCI: Charlson comorbidity index; P-POSSUM: Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity; SMD: Standardized mean difference; N/A: Not applicable; PSM: Propensity score matching.

Table 2 Intraoperative characteristics of patients who underwent elective major colorectal surgery

	Overall group, N = 208				PSM group, n = 144
	Prehabilitation (n = 148)	No prehabilitation (n = 60)	OR (95%CI)1	P value1	Prehabilitation (n = 96)	No prehabilitation (n = 48)	OR (95%CI)1	P value1	OR (95%CI)2	P value2
Open conversion	9/68 (13.2)	5/37 (13.5)	0.98 (0.30, 3.16)	0.968	7/66 (12.7)	5/53 (19.2)	0.61 (0.17, 2.15)	0.442	0.60 (0.17, 2.13)3	0.4333
Primary anastomosis, yes	124 (83.8)	56 (93.3)	0.37 (0.12, 1.11)	0.068	85 (88.5)	45 (93.8)	0.52 (0.14, 1.94)	0.320	0.47 (0.12, 1.79)	0.268
Stoma creation, yes	34 (23.0)	13 (21.7)	1.08 (0.52, 2.22)	0.838	19 (19.8)	9 (18.8)	1.07 (0.44, 2.58)	0.882	1.15 (0.47, 2.83)	0.758
Operating time, minute
Mean (mean ± SD)	215.6 ± 77.3	231.0 ± 76.6	N/A	0.194	225.8 ± 64.9	223.9 ± 78.1	N/A	0.884
Median	203.5 (164.3-265.8)	228.5 (165.0-275.8)	N/A	0.139	214.0 (177.8-269.0)	225.5 (152.5-274.0)	N/A	0.760
Estimated blood loss ≥ 500 mL, yes	9 (6.1)	2 (3.3)	1.88 (0.39, 8.96)	0.422	6 (6.3)	2 (4.2)	1.53 (0.30, 7.90)	0.607	1.76 (0.33, 9.48)	0.509
Intraoperative blood transfusion	21 (14.2)	8 (13.3)	1.08 (0.45, 2.58)	0.872	12 (12.5)	7 (14.6)	0.84 (0.31, 2.28)	0.728	0.88 (0.32, 2.46)	0.812
Intraoperative inotropes use	2 (1.4)	2 (3.3)	0.40 (0.06, 2.89)	0.346	2 (2.1)	1 (2.1)	1.00 (0.09, 11.31)	1.000	1.09 (0.09, 12.78)	0.945

¹Univariate analysis.

²Multivariate analysis.

³Multivariate analysis excluded the variable (surgical access).

Data are presented as median (interquartile range) or n (%). OR: Odds ratio; CI: Confidence interval; N/A: Not applicable; SD: Standard deviation; PSM: Propensity score matching.

Table 3 Postoperative outcomes in patients who received prehabilitation vs those who did not receive prehabilitation

	Overall group, N = 208				PSM group, n = 144
	Prehabilitation (n = 148)	No prehabilitation (n = 60)	OR (95%CI)1	P value1	Prehabilitation (n = 96)	No prehabilitation (n = 48)	OR (95%CI)1	P value1	OR (95%CI)2	P value2
Admission to ICU/HDU	59 (39.9)	19 (31.7)	1.43 (0.76, 2.70)	0.269	35 (36.5)	16 (33.3)	1.15 (0.55, 2.38)	0.712	1.19 (0.54, 2.63)	0.665
Unplanned	8 (13.6)	5 (26.3)	0.44 (0.12, 1.56)	0.194	6 (17.1)	5 (31.3)	0.46 (0.12, 1.80)	0.256	0.55 (0.13, 2.31)	0.417
Postoperative complications
Major morbidity	17 (11.5)	8 (13.3)	0.84 (0.34, 2.07)	0.711	12 (12.5)	7 (14.6)	0.84 (0.31, 2.28)	0.728	0.84 (0.30, 2.33)	0.735
Grade 3	8 (5.4)	4 (6.7)	0.80 (0.23, 2.76)	0.724	6 (6.3)	4 (8.3)	0.73 (0.20, 2.73)	0.643	0.71 (0.19, 2.68)	0.617
Grade 4	7 (4.7)	2 (3.3)	1.44 (0.29, 7.14)	0.654	4 (4.2)	2 (4.2)	1.00 (0.18, 5.66)	1.000	1.01 (0.17, 6.06)	0.993
Grade 5	2 (1.4)	2 (3.3)	0.40 (0.06, 2.89)	0.346	2 (2.1)	1 (2.1)	1.00 (0.09, 11.31)	1.000	0.93 (0.08, 11.19)	0.953
Length of stay, days
Mean (mean ± SD)	9.9 ± 9.8	9.3 ± 7.4	N/A	0.670	9.8 ± 10.5	9.1 ± 6.6	N/A	0.616	N/A	N/A
Median	7.0 (5.0-11.0)	7.0 (5.0-11.0)	N/A	0.349	7.0 (5.0-11.0)	7.0 (4.3-10.8)	N/A	0.835	N/A	N/A
≥ 14 days	28 (18.9)	13 (21.7)	0.84 (0.40, 1.77)	0.652	18 (18.8)	10 (20.8)	0.88 (0.37, 2.08)	0.766	0.87 (0.36, 2.11)	0.754
Discharge disposition			N/A	0.359			N/A	0.793	N/A	N/A
Home	121 (82.3)	52 (89.7)	N/A	N/A	86 (90.5)	41 (87.2)	N/A	N/A	N/A	N/A
Community hospital	24 (16.3)	5 (8.6)	N/A	N/A	8 (8.4)	5 (10.6)	N/A	N/A	N/A	N/A
Nursing home	2 (1.4)	1 (1.7)	N/A	N/A	1 (1.1)	1 (2.1)	N/A	N/A	N/A	N/A
30-day readmission	16 (10.9)	11 (18.6)	0.53 (0.23, 1.23)	0.136	9 (9.5)	8 (16.7)	0.52 (0.19, 1.46)	0.209	0.53 (0.19, 1.49)	0.230
Mortality
30-day	2 (1.4)	2 (3.3)	0.40 (0.06, 2.89)	0.346	2 (2.1)	1 (2.1)	1.00 (0.09, 11.31)	1.000	0.93 (0.08, 11.19)	0.953
1-year	10 (6.8)	4 (6.7)	1.01 (0.31, 3.37)	0.981	7 (7.3)	3 (6.3)	1.18 (0.29, 4.78)	0.817	1.26 (0.30, 5.28)	0.756
MBI at 6 weeks postoperatively	100 (87.8-100)	100 (98.0-100)	N/A	0.069	100 (98.0-100)	100 (94.5-100)	N/A	0.777	N/A	N/A
> 10% drop in MBI 6 weeks after surgery, yes	18 (12.2)	5 (8.3)	1.52 (0.54, 4.31)	0.425	9 (9.4)	4 (8.3)	1.14 (0.33, 3.90)	0.837	1.18 (0.34, 4.09)	0.797

¹Univariate analysis.

²Multivariate analysis.

Data are presented as median (interquartile range) or n (%). ICU: Intensive care unit; HDU: High dependency unit; MBI: Modified Barthel index; OR: Odds ratio; CI: Confidence interval; N/A: Not applicable; PSM: Propensity score matching; SD: Standard deviation.

Table 4 Postoperative outcomes in the subgroup analysis of patients who were not frail

	Overall group, N = 142				PSM group, n = 119
	Prehabilitation (n = 91)	No prehabilitation (n = 51)	OR (95%CI)1	P value1	Prehabilitation (n = 79)	No prehabilitation (n = 40)	OR (95%CI)1	P value1	OR (95%CI)2	P value2
Admission to ICU/HDU	41 (45.1)	15 (29.4)	1.97 (0.95, 4.09)	0.067	33 (41.8)	13 (32.5)	1.49 (0.67, 3.31)	0.326	1.50 (0.63, 3.57)	0.360
Unplanned	7 (17.1)	4 (26.7)	0.57 (0.14, 2.31)	0.424	6 (18.2)	4 (30.8)	0.50 (0.12, 2.18)	0.351	0.57 (0.12, 2.63)	0.469
Postoperative complications
Major morbidity	13 (14.3)	7 (13.7)	1.05 (0.39, 2.82)	0.927	11 (13.9)	7 (17.5)	0.76 (0.27, 2.15)	0.607	0.75 (0.26, 2.14)	0.588
Grade 3	6 (6.6)	4 (7.8)	0.83 (0.22, 3.09)	0.780	6 (7.6)	4 (10.0)	0.74 (0.20, 2.79)	0.655	0.74 (0.19, 2.81)	0.655
Grade 4	6 (6.6)	2 (3.9)	1.73 (0.34, 8.90)	0.508	4 (5.1)	2 (5.0)	1.01 (0.18, 5.78)	0.988	0.98 (0.16, 6.00)	0.984
Grade 5	1 (1.1)	1 (2.0)	0.56 (0.03, 9.08)	0.676	1 (1.3)	1 (2.5)	0.50 (0.03, 8.21)	0.621	0.44 (0.03, 7.69)	0.574
Length of stay, days
Mean (mean ± SD)	10.38 ± 11.79	9.45 ± 7.86	N/A	0.614	9.86 ± 11.20	9.20 ± 7.04	N/A	0.734	N/A	N/A
Median	7.0 (5.0-11.0)	6.0 (4.0-11.0)	N/A	0.411	7.0 (5.0-11.0)	6.5 (4.0-10.8)	N/A	0.717	N/A	N/A
≥ 14 days	16 (17.6)	12 (23.5)	0.69 (0.30, 1.61)	0.393	14 (17.7)	9 (22.5)	0.74 (0.29, 1.90)	0.533	0.71 (0.27, 1.85)	0.484
Discharge disposition			N/A	0.696			N/A	0.640	N/A	N/A
Home	81 (90.0)	46 (92.0)			72 (92.3)	35 (89.7)
Community hospital	9 (10.0)	4 (8.0)			6 (7.7)	4 (10.3)
Nursing home	0	0			0	0
30-day readmission	9 (9.9)	10 (19.6)	0.45 (0.17, 1.19)	0.103	8 (10.1)	7 (17.5)	0.53 (0.18, 1.59)	0.252	0.55 (0.18, 1.66)	0.292
Mortality
30-day	1 (1.1)	1 (2.0)	0.56 (0.03, 9.08)	0.676	1 (1.3)	1 (2.5)	0.50 (0.03, 8.21)	0.621	0.44 (0.03, 7.69)	0.574
1-year	6 (6.6)	3 (5.9)	1.13 (0.27, 4.72)	0.867	6 (7.6)	3 (7.5)	1.01 (0.24, 4.28)	0.985	1.04 (0.24, 4.55)	0.961
MBI at 6 weeks postoperatively	100 (98.5-100)	100 (100-100)	N/A	0.770	100 (99.0-100)	100 (98.0-100)	N/A	0.866	N/A	N/A
> 10% drop in MBI 6 weeks after surgery, yes	7 (7.7)	4 (7.8)	0.98 (0.27, 3.52)	0.974	6 (7.6)	3 (7.5)	1.01 (0.24, 4.28)	0.985	1.11 (0.25, 4.98)	0.892

¹Univariate analysis.

²Multivariate analysis.

Data are presented as median (interquartile range) or n (%). ICU: Intensive care unit; HDU: High dependency unit; MBI: Modified Barthel index; OR: Odds ratio; CI: Confidence interval; N/A: Not applicable; PSM: Propensity score matching; SD: Standard deviation.