Page 141 - Risk quantification and modification in older patients with colorectal cancer

Prehabilitation in a multidisciplinary care program
30-45 minutes. Also, instructions for home-exercises and breathing exercises were given.
Patients extremely fit, or patients with obstructing tumour were not deemed eligible for preoperative physical training, but could however participate in the postoperative program of rehabilitation.
The Enhanced Recovery After Surgery (ERAS) guidelines22 were implemented in 2008 as part of standard care for all surgical patients. At the day of admission prior to surgery, a standardised preoperative geriatric interview was performed by nurses. Laparoscopic surgery was the technique of choice unless previous surgical history or patient’s condition prevented its safe application.
At day 6, the postoperative discharge was planned to a rehabilitation facility for as long as necessary to become self-supporting at home. When patients were self-supporting before day 6, they went home. Rehabilitation care included a local program of physical training, dietary support and cognitive and emotional guidance. Short-postoperative follow-up after discharge was individualised when patients were in a rehabilitation centre. Our program was initiated as standard of care. However, patients could decide not to participate.
For this study, patients were considered to participate in our comprehensive multidisciplinary care program when preoperative prehabilitation and or rehabilitation was initiated.
Data collection
Patient demographic data, as well as outcome data, were retrieved from the Dutch ColoRectal Audit (DCRA) and Electronic Hospital Records (EMR). The DCRA contains pre-, peri- and postoperative surgical outcome data on all operated CRC patients in the Netherlands as part of a national quality improvement project. All patients are prospectively enrolled in this database and data entry is done by a qualified data-entry manager or nurse. Detailed information on this initiative was published elsewhere.23
Demographic information included ASA score, comorbidity from which a Charlson Comorbidity Index (CCI) score24 was calculated and tumour stage
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