Functional capacity of prediabetic patients: effect of multimodal prehabilitation in patients undergoing colorectal cancer resection

Abstract

Background Prehabilitation is the process of increasing functional capacity (FC) before surgery. Poor glycemic control is associated with worse outcomes in patients undergoing surgery. Therefore, prediabetic patients could particularly benefit from prehabilitation. Methods This is a pooled analysis of individual patient data from three multimodal prehabilitation trials in colorectal cancer surgery. Following a baseline assessment using the 6-minute walking test (6MWT), subjects were randomized to multimodal prehabilitation or to a control group. Participants were reassessed 24 h before surgery and 4 weeks after surgery. Prediabetes (PreDM) was defined as HbA1c 5.7%–6.4%. Multivariable logistic regression was used to adjust for potentially confounding variables. Results Participation in a prehabilitation program was the most important predictive factor of clinical improvement in FC prior to surgery (Adjusted OR 2.42, 95% CI 1.18, 4.94); prediabetes was not a statistically significant predictor of improvement in FC after adjustments for covariates. Prehabilitation attenuated the loss of FC in unadjusted analyses after surgery in prediabetic patients (PreDM Control: median change −6 m [IQR −50–20] vs PreDM Prehab: median change +25 m [IQR −20–53], p = 0.045). Adjusted analyses also suggested the protective effect against loss of FC after surgery was stronger in prediabetic patients (PreDM Prehab vs PreDM Control: OR 5.5, 95% CI: 1.2–25.8; Normo Prehab vs Normo Control: OR 1.5, 95% CI: 0.53–4.52). Conclusions Multimodal prehabilitation favored clinical recovery of FC after surgery in CRC patients, especially prediabetic patients.