Authors (including presenting author) :
Tam KS(1), Au TK(1), Fung YK(1), Ngan KTS(1), Yuen KY(2), Tam WY(2), Choi WW(1), Tam CL(1), Leung TF(1), Wong WS(1), Fan SM(1)
Affiliation :
(1)Physiotherapy Department (Integrated Rehabilitation Services, (2)Department of Surgery, Tseung Kwan O Hospital
Introduction :
Enhanced Recovery After Surgery (ERAS) is an evidence-based multidisciplinary perioperative management approach for patients undergoing major surgery. Numerous studies revealed patients under ERAS Program have dramatically lower post-operative complications and shorter recovery time when compared to standard care. Colorectal cancer, the commonest cancer in Hong Kong (17.3%, Hong Kong Cancer Registry, 2016), was chosen as the target patient group to implement the pilot ERAS program in Tseung Kwan O Hospital since 2016. Physiotherapy, as one of the core components in the ERAS, aims to provide pre-operative assessment, pre-habilitation and post-operative early mobilization.
Objectives :
To review the Physiotherapy service in ERAS for colorectal cancer patients.
Methodology :
Pre-operative Risk Stratification Colorectal cancer patients scheduled for surgery were referred for assessment of respiratory condition, functional capacity with six-minute walk test (6MWT) and hand grip strength (HGS). Patients with 6MWT distance ≤ 350 meters, HGS below normative data and comorbidities were triaged as high risk group. Pre-habilitation
Tailor-made pre-habilitation exercises were prescribed to optimize physical fitness for high risk or borderline patients while waiting for surgery. Post-operative Phase
Chest physiotherapy and supervised early graded mobilization were started on post-operative day 1. Patient management plans were discussed during weekly multidisciplinary combined ward round.
Result & Outcome :
From February, 2016 to November, 2018, 294 patients participated in the program. Mean age was 67.6±10.3, male 63.6%. Mean pre-habilitation period was 28.1 days. Ninety percent of patients mobilized out of bed on post-operative day 1 to 2. Rate of post-operative complications reduced from 37.3% to 21.4% and median length of stay (LOS) was shortened from 9 to 5 days compared with before program implementation. All patients participating in pre-habilitation reported they performed regular exercises at least 3 times/week pre-operatively and 97% of patients agreed the benefit of training in preparation for surgery. Conclusions
ERAS for Colorectal Surgery has been proved effective in enhancing recovery and shortening LOS through multidisciplinary input. Physiotherapy is important in pre-operative assessment, enhancing cardiopulmonary fitness and post-operative management to reduce complications. In view of the success of ERAS program in colorectal surgery, incorporating ERAS elements in other major surgeries should be promoted.
Co-location with:
