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Acta Oncol. 2019 Feb 6:1-6. doi: 10.1080/0284186X.2018.1557343. [Epub ahead of print]

The impact of improved functional capacity before surgery on postoperative complications: a study in colorectal cancer.

Author information

1
a Department of Anesthesia , McGill University Health Center, Montreal General Hospital , Montréal , QC, Canada.
2
b Department of Surgery , McGill University Health Center, Montreal General Hospital , Montréal , QC, Canada.
3
c Department of Community Health Sciences, Cumming School of Medicine , University of Calgary , Calgary , AB, Canada.
4
d Research Institute, McGill University Health Center , Glen Site, Boulevard Décarie, Montréal , QC, Canada.

Abstract

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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