Page 145 - Risk quantification and modification in older patients with colorectal cancer

Prehabilitation in a multidisciplinary care program Table 2 Preoperative interventions, preoperative complications and surgical approach
Laparoscopic
Open
Primary Anastomosis (%)
44 (70) 63 (84) 71 (83) 19 (30) 12 (16) 15 (17)
2010-2011
n=63
Prehabilitation (%)
None - Local - Out-patiënt in a Rehabilitation center - In-patiënt in a Rehabilitation center -
Geriatric Consultation (%) - Dietitian Consultation (%) - Preoperative Treatment (%) -
Radiotherapy 8 Chemoradiation 4 Diverting Stomy 1
Peroperative Ileus (%) 1 Surgical Approach (%)
2012-2013 2014-2015
n=75 n=86
- 32 (37) a - 25 (29) - 24 (28) - 5 (6) - 34 (40) - 74 (86) -
(13) 12 (16) 13 (15)
p-value
0.9
0.8
(6) 2 (2) 0 (2) 1
(3) 2 (2) 1 (1) (1) 4 (5)
49 (78) 55 (73)
62 (72) 0.8
2010-2011 and 2012-2013, control cohort; 2014-2015, study cohort, IQR, interquartile range; %, percentage; SD, standard deviation. aIncluding 13 patients that did not participate in the program
Primary and secondary outcomes
In Figure 1, primary and secondary outcomes for the three cohorts are shown. One year mortality was in 11% (n=7) in 2010-2011, 5 % (n=4) in 2012-2013 and 3% (n=3) in 2014-2015. Compared to 2010-2011, this improvement did not reach statistical significance (OR 0.3 95% CI 0.1-1.2, p=0.08). In the study cohort, two patients died within 30 days of surgery due to surgical complications. Notably, one of the early postoperative deaths was considered a medical calamity due to stapler failure and was reported to the Dutch Inspection for Health. The full overview of causes of death in both the study cohort as well as the control cohorts can be found in Appendix B.
Concerning secondary outcomes, the number of patients with any complications after surgery decreased from 38 % (n=24) in 2010-2011 to 29% (n=22) in 2012- 2013 and 30% (n=26) in 2014-2015. The number of surgical complications did not differ between the three cohorts, although a slight increase was seen in 2012-2013 (13% to 17%). There was a significant decrease of 8% in cardiac complications, from 8% in 2010-2011 (n=5) to none in 2014-2015 (Fisher-exact test, p=0.01) and no difference in pulmonary complications (p=0.3). The number of patients with a severe complication decreases from 32% (n=20) in 2010-2011 to 17% (n=13) in
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