Authors (including presenting author) :
Wong HL(1), Tso AWH(1), Chung KHL (1), Wan HHT(1), Leung AKP(1), Chu CWH(2), Chan ACM(1)
Affiliation :
(1) Physiotherapy Department, Queen Elizabeth Hospital
(2) Department of Surgery, Queen Elizabeth Hospital
Introduction :
Enhanced Recovery After Surgery (ERAS) was implemented at Queen Elizabeth Hospital in October 2022, aiming at improving care for patients undergoing major surgeries. As part of the ERAS team, a physiotherapy prehabilitation program (PT) was introduced to evaluate baseline functional levels and implement interventions to reduce future impairments. The 6-Minute Walk Test was utilized to measure functional walking capacity with a 6-Minute Walk Distance (6MWD) cut-off of 400m. A low 6MWD was associated with a higher incidence of postoperative complications (complications) (up to 61%) compared to 21% in patients meeting the threshold. Tailored department- or home-based exercise programs were provided. However, the relationship between preoperative 6MWD and complications has not yet been studied in local context.
Objectives :
To evaluate the association of preoperative 6MWD and complications after elective colorectal surgery.
Methodology :
A retrospective study was conducted with the Department of Surgery at QEH, focusing on patients eligible for elective colorectal cancer surgery. These patients participated in PT that included physiotherapy assessment, patient education, and an exercise training regimen to enhance physical condition. Clinical information was retrieved from the patient records. Complications were evaluated using the Comprehensive Complications Index (CCI), ranging from 0 (no complication) to 100 (death). The Chi-Square Test of Independence assessed the relationship between preoperative 6MWD and complications.
Result & Outcome :
From October 2022 to December 2024, 290 patients (161 males, 129 females; mean age of 69.6±9.3 years) diagnosed with colorectal cancer completed the PT and underwent surgery (253 using a laparoscopic approach, 37 using an open approach). The mean 6MWD was 385±100 m. The median (interquartile range (IQR)) blood loss during surgery was 100 (50–153) mL. The median (IQR) length of stay was 7.5 (6–11) days. Complications occurred in 65 patients (22.4%), with 11 (3.8%) experiencing severe complications defined by a CCI≥33.7. The results revealed that the preoperative 6MWD was independent of complications in both entire population (p = 0.155) and the elderly population aged 65 or above (212 patients, p = 0.230) after subgroup analysis.
Despite low mean preoperative 6MWD below the cut-off value, the incidence of complications after colorectal surgery did not increase. This superior surgical outcome might be attributed to the multidisciplinary ERAS team effort, along with PT for better patient preparation before surgery.
