The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison.
The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison.
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DOI：
10.1007/s11605-020-04881-3
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Moorthy K
中科院分区：
文献类型：
--
作者：
Halliday LJ;Doganay E;Wynter-Blyth VA;Hanna GB;Moorthy K
接受食道癌手术的患者通常身体虚弱，术后并发症的风险很高。预康复已被证明可以减少特定患者群体的术后并发症，但食管癌患者的证据尚无定论。 2016年1月至2019年4月期间，所有在专科三级中心接受根治性治疗的可切除食管癌患者都参加了个性化的、以家庭为基础的多模式预康复计划。该组的术后并发症和住院时间与对照组进行了比较。倾向评分匹配用于控制基线特征的差异。对 72 名完成预康复治疗的患者和 39 名对照患者进行了研究；经过倾向评分匹配后，每组有 38 名受试者。与匹配对照相比，康复组患者术后肺炎发生率较低（康复= 26%；对照= 66%；p = 0.001），住院时间较短（康复=中位10天，IQR 8-17天；对照=中位13天，IQR 11-20天；p = 0.018）。多变量回归分析显示，参与预康复治疗可使术后肺炎发生率降低 77%（OR 0.23，95% CI 0.09 至 0.55 p = 0.001）。总体并发症或严重并发症的发生率无显着差异。预康复与食管切除术后肺炎发生率较低和住院时间较短有关。这种基于家庭、个性化和监督的康复模式是有效的，并且与集中癌症服务相关。
Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive. Between January 2016 and April 2019, all patients with resectable oesophageal cancer who underwent curative treatment at a specialist tertiary centre participated in a personalised, home-based, multimodal prehabilitation programme. Post-operative complications and hospital stay in this group were compared to a control sample. Propensity score matching was used to control for differences in baseline characteristics. Seventy-two patients who completed prehabilitation and 39 control patients were studied; following propensity score matching, there were 38 subjects in each group. In comparison to matched controls, patients in the prehabilitation group had a lower incidence of post-operative pneumonia (prehabilitation = 26%; control = 66%; p = 0.001) and a shorter length of stay (prehabilitation = median 10 days, IQR 8–17 days; control = median 13 days, IQR 11–20 days; p = 0.018). On multivariate regression analysis, participation in prehabilitation was associated with a 77% lower incidence of post-operative pneumonia (OR 0.23, 95% CI 0.09 to 0.55 p = 0.001). There was no significant difference in the incidence of overall complications or severe complications. Prehabilitation was associated with a lower incidence of post-operative pneumonia and shorter hospital length of stay following oesophagectomy. This model of home based, personalised, and supervised prehabilitation is effective and relevant to centralised cancer services.
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作者：
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