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

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.

Acknowledgments

The authors thank the personnel of the McGill University Health Center (Montreal, QC, Canada) Colorectal Clinic for helping with the recruitment, Immunotec Inc. (QC, Canada) for graciously supplying the whey protein powder, and Mary Guay, B.A., for her support with the organization.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The funding was provided by the Montreal General Hospital Foundation, and the Peri Operative Program (POP) Charitable Foundation, Montreal QC Canada. Dr E.M.M. received educational and research grants from the Cedar Cancer Institute (Henry R Shibata Fellowship Award), and MITACS (Accelerate Fellowship Program), Canada.