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Inicio Cirugía Española (English Edition) A single-center prospective observational study on the effect of trimodal prehab...
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Vol. 98. Issue 10.
Pages 605-611 (December 2020)
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Vol. 98. Issue 10.
Pages 605-611 (December 2020)
Original article
DOI: 10.1016/j.cireng.2020.11.006
A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery
Estudio observacional prospectivo unicéntrico sobre el efecto de la prehabilitación trimodal en cirugía colorrectal
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L. Mora Lópeza,
Corresponding author
mora.lopez.laura@gmail.com

Corresponding author.
, A. Pallisera Lloveraa, X. Serra-Aracila, S. Serra Plaa, V. Lucas Guerreroa, P. Rebasad, C. Tremps Domínguezb, G. Pujol Caballéb, R. Martínez Castelab, L. Subirana Giménezb, J. Martínez Cabañerob, C. del Pino Zuritac, C. Agudo Arcosc, F.G. Carol Boerisb, S. Navarro Sotoe
a Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
b Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
c Enfermera Grupo Rehabilitación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
d Unidad de Esofagogastroesofágica, Servicio de Cirugía, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
e Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
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Tables (3)
Table 1. Prehabilitated population characteristics and comparison with the historical population.
Table 2. Morbidity results of the prehabilitation group and comparison with the historical population.
Table 3. Analysis of the morbidity results according to ASA group.
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Abstract
Introduction

A trimodal prehabilitation protocol was designed with the aim to evaluate whether it contributes to reducing postoperative morbidity, to evaluate the effect of prehabilitation on overall hospital stay, and to analyze the evolution of functional capacity before and after surgery.

Methods

A single-center observational study of patients with colorectal cancer who underwent surgery with curative intent after a trimodal prehabilitation protocol. We collected data for postoperative morbidity according to the Comprehensive Complication Index and hospital stay, which were compared with a historical matrix. Functional capacity data were also collected before and after the application of the prehabilitation protocol.

Results

Compared to the historical population, the overall Comprehensive Complication Index was reduced from 13.2 to 11.5, which was statistically significant. Analyzed by morbidity type, all decreased in percentage, although without achieving significance (surgical site infection from 11.7% to 8.4%, nosocomial infection 15.8 to 10% and medical morbidity 8.6% to 4.2%). The overall hospital stay went from 6 to 4 days, and the decrease in the percentage of patients who prepared at home was statistically significant in both cases.

Conclusions

Trimodal prehabilitation can contribute to lowering the postoperative morbidity and overall hospital stay of patients undergoing colorectal cancer surgery.

Keywords:
Trimodal prehabilitation
Colorectal cancer surgery
Morbidity
Comprehensive complication index
Hospital stay
Adverse effect
Resumen
Introducción

Se ha diseñado un protocolo de prehabilitación trimodal con el objetivo de valorar si contribuye a disminuir la morbilidad postoperatoria, valorar el efecto de la prehabilitación en la estancia hospitalaria global y analizar la evolución de la capacidad funcional antes y después de cirugía.

Métodos

Estudio observacional unicéntrico con pacientes con cáncer colorrectal intervenidos quirúrgicamente con intención curativa después de un protocolo de prehabilitación trimodal. Se recoge morbilidad postoperatoria según el Comprehensive Complication Index y estancia hospitalaria, y se compara con una matriz histórica. También se recoge capacidad funcional antes y después de la aplicación del protocolo de prehabilitación.

Resultados

En comparación con la población histórica se consigue disminuir el Comprehensive Complication Index global de forma estadísticamente significativa de 13,2 a 11,5. Desglosando por tipo de morbilidad, todas disminuyen en porcentaje sin conseguir significación (infección espacio quirúrgico del 11,7 al 8,4%; infección nosocomial del 15,8 al 10%, y morbilidad médica del 8,6 al 4,2%). La estancia hospitalaria global pasa de 6 a 4 días y el porcentaje de pacientes que se preparan en casa disminuye de forma estadísticamente significativa en ambos casos.

Conclusiones

La prehabilitación trimodal puede contribuir a disminuir la morbilidad postoperatoria y la estancia hospitalaria global de los pacientes intervenidos de neoplasia colorrectal.

Palabras clave:
Prehabilitación trimodal
Cirugía cáncer colorrectal
Morbilidad
Comprehensive complication index
Estancia hospitalaria
Efecto adverso

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