Effect of prehospital multimodal prehabilitation on preoperative function and postoperative recovery in patients with gastrointestinal malignant tumors

doi:10.3969/j.issn.1674-8115.2024.10.003

Abstract

Abstract:

Objective ·To explore the effect of a prehospital multimodal prehabilitation program on the preoperative functional status and postoperative recovery of patients with gastrointestinal malignant tumors. Methods ·A total of 78 patients with gastrointestinal malignant tumors, hospitalized in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from June to December 2023, were enrolled. They were divided into the standard group (SD group, n=40) and the prehospital multimodal prehabilitation group (PMP group, n=38) by using random number table. From the time the operation was agreed upon by both the doctor and patient to the day before the operation, the SD group followed the routine preoperative guidance, while the PMP group received a home-based prehospital multimodal prehabilitation program. The general data of patients were collected, and the six-minute walk distance (6MWD) was compared between the two groups at baseline and on the day before operation.The length of postoperative hospitalization, time to first flatus, time to first ambulation, time to first oral intake, drainage removal time and postoperative complication rate were also compared between the two groups. Results ·There was no difference in general data and duration of preoperative intervention of patients between the two groups. At baseline, there was no significant difference in 6MWD between the two groups. On the day before operation, the 6MWD in the PMP group was higher than that in the SD group (P= 0.016). Changes in 6MWD in the PMP group were significantly higher compared to SD group during the preoperative period, with values of (23.42±13.59) m vs. (-3.75±12.08) m (P<0.001). Time to first flatus, time to first ambulation and time to first oral intake in the PMP group were earlier than those in the SD group (P<0.05). However, there was no significant difference in drainage removal time, postoperative hospitalization and postoperative complication rate between the two groups (P>0.05). Conclusion ·Prehospital multimodal prehabilitation can improve the preoperative function and accelerate the postoperative recovery in patients with gastrointestinal malignancies.

Key words: gastrointestinal surgery, multimodal prehabilitation, perioperative, functional capability, postoperative recovery

CLC Number:

R473.6

TAI Rui, SUN Jufang, LIN Ying, ZHANG Yaqing, HUANG Chen, FANG Fang. Effect of prehospital multimodal prehabilitation on preoperative function and postoperative recovery in patients with gastrointestinal malignant tumors[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1229-1234.

Figures/Tables 3

TrendMD

References 21

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Item	SD group (n=40)	PMP group (n=38)	t/χ² value	P value
Age/year	66.52±9.26	67.82±9.17	-0.618	0.538
BMI/(kg·m^-2)	23.22±2.93	24.40±4.00	-1.493	0.140
Gender/n(%)			0.435	0.509
Male	23 (57.4)	19 (50.0)
Female	17 (42.6)	19 (50.0)
Registered residence/n(%)			0.503	0.478
City	35 (87.5)	31 (81.6)
Town	2 (5.0)	3 (7.9)
Country	3 (7.5)	4 (10.5)
Education/n(%)			1.528	0.216
Junior high and below	24 (60.0)	27 (71.0)
Technical secondary school/senior high school	9 (22.5)	9 (23.6)
Junior college	6 (15.0)	1 (2.7)
Bachelor's degree or above	1 (2.5)	1 (2.7)
Tumor site/n(%)			1.185	0.276
Gastric cancer	14 (35.0)	9 (32.1)
Colorectal cancer	26 (65.0)	29 (67.9)
Hypertension/n(%)			2.466	0.116
Yes	16 (40.0)	22 (57.9)
No	24 (60.0)	16 (45.1)
Diabetes mellitus/n(%)			1.140	0.286
Yes	9 (22.5)	5 (13.2)
No	31 (77.5)	33 (86.8)
Other comorbidity/n(%)			1.233	0.267
Yes	5 (12.5)	2 (5.3)
No	35 (87.5)	36 (94.7)
Duration of prehabilitation/d	6.90±1.11	7.05±1.06	-0.412	0.681

Item	SD group (n=40)	PMP group (n=38)	t/χ² value	P value
Age/year	66.52±9.26	67.82±9.17	-0.618	0.538
BMI/(kg·m^-2)	23.22±2.93	24.40±4.00	-1.493	0.140
Gender/n(%)			0.435	0.509
Male	23 (57.4)	19 (50.0)
Female	17 (42.6)	19 (50.0)
Registered residence/n(%)			0.503	0.478
City	35 (87.5)	31 (81.6)
Town	2 (5.0)	3 (7.9)
Country	3 (7.5)	4 (10.5)
Education/n(%)			1.528	0.216
Junior high and below	24 (60.0)	27 (71.0)
Technical secondary school/senior high school	9 (22.5)	9 (23.6)
Junior college	6 (15.0)	1 (2.7)
Bachelor's degree or above	1 (2.5)	1 (2.7)
Tumor site/n(%)			1.185	0.276
Gastric cancer	14 (35.0)	9 (32.1)
Colorectal cancer	26 (65.0)	29 (67.9)
Hypertension/n(%)			2.466	0.116
Yes	16 (40.0)	22 (57.9)
No	24 (60.0)	16 (45.1)
Diabetes mellitus/n(%)			1.140	0.286
Yes	9 (22.5)	5 (13.2)
No	31 (77.5)	33 (86.8)
Other comorbidity/n(%)			1.233	0.267
Yes	5 (12.5)	2 (5.3)
No	35 (87.5)	36 (94.7)
Duration of prehabilitation/d	6.90±1.11	7.05±1.06	-0.412	0.681

Variable	SD group (n=40)	PMP group (n=38)	t value	P value
6MWD/m
Baseline	405.50±48.95	406.05±42.30	-0.053	0.958
Preoperative	401.75±50.91	429.47±48.10	-2.469	0.016
Changes of 6MWD from baseline /m	-3.75±12.08	23.42±13.26	-9.470	<0.001

Variable	SD group (n=40)	PMP group (n=38)	t value	P value
6MWD/m
Baseline	405.50±48.95	406.05±42.30	-0.053	0.958
Preoperative	401.75±50.91	429.47±48.10	-2.469	0.016
Changes of 6MWD from baseline /m	-3.75±12.08	23.42±13.26	-9.470	<0.001

Variable	SD group (n=40)	PMP group (n=38)	t/χ² value	P value
Length of postoperative hospitalization /d	8.71±2.56	8.42±3.13	0.471	0.639
Time to first flatus/d	3.13±0.99	2.58±1.03	2.385	0.020
Time to first oral intake/d	3.25±1.46	2.42±1.52	2.456	0.016
Time to first ambulation/d	3.63±1.00	2.76±0.75	4.273	<0.001
Drainage removal time/d	7.85±2.65	7.89±2.76	-0.074	0.941
Patients with complications/n(%)			3.738	0.053
Yes	8 (20.0)	3 (7.9)
No	32 (80.0)	35 (92.1)