Participation in Virtual Prehabilitation and Outcomes Following Thoracic Cancer Surgery

This cohort study evaluates the association of a virtual synchronized prehabilitation program with perioperative outcomes among patients undergoing thoracic cancer surgery.


Introduction
The American Society of Clinical Oncology (ASCO) clinical guideline recommends prehabilitation exercise for patients with lung cancer undergoing surgery to reduce postoperative complications. 1 However, the COVID-19 pandemic presented challenges to accessing on-site exercise programs, and limited research has evaluated virtual platforms for prehabilitation programs in cancer settings.This study aimed to evaluate the association of a virtual synchronized prehabilitation program with perioperative outcomes among patients undergoing thoracic cancer surgery.

Methods
This cohort study followed the STROBE reporting guideline.This study was approved by the institutional review board of Memorial Sloan Kettering Cancer Center under a retrospective protocol.
Informed consent was waived because of the retrospective nature of the study.
We conducted a retrospective cohort study at the thoracic oncology surgical department of an academic cancer center from December 2019 to December 2021.Eligible patients were 18 years or older with a thoracic cancer diagnosis and expected thoracic surgery between December 2019 and December 2021.The prehabilitation program offered 2 free weekly 45-minute preoperative virtual mind-body fitness classes with the same content to help these patients prepare for surgery between December 2020 to December 2021. 2 Patients who attended at least 1 class prior to surgery were included in the analysis (prehabilitation group).We randomly selected 400 control patients who were not approached to enroll in the prehabilitation program from December 2019 to December 2021.Cohorts were stratified by cancer type (lung, esophageal, other) to match the cancer type proportions in the prehabilitation group (±5%).Using electronic medical records, we extracted length of hospital stays (LOS) and whether they had a hospital readmission or urgent care center (UCC) visit within 30 days of discharge.
Descriptive statistics were used to summarize demographic and clinical variables.We compared LOS between prehabilitation, and control groups using a Wilcoxon rank-sum test and compared 30-day hospital readmission and UCC visits using Pearson χ 2 tests.A multivariable logistic regression model was built to estimate hospital readmission and included covariates associated with the outcome (P < .10) in the univariable analyses.All tests were 2-sided, and the significance was set at P <.05.Stata version 13.0 (StataCorp) was used for analyses.Data were analyzed from December 2022 to June 2023.

Results
Among

Discussion
Participation in a virtual synchronous prehabilitation program was associated with fewer hospital readmissions within 30 days of discharge compared with not participating.Hospital readmission is an important metric for quality of care and health care costs.Although prior research demonstrated various benefits of prehabilitation on perioperative outcomes, 3 few studies have explored the association of prehabilitation with hospital readmissions among this population, and those that have, reported either no difference 4,5 or a difference that was not statistically significant 6 between groups.

Table 1 .
Patient Characteristics and Outcomes Among Patients Who Participated in the Prehabilitation Program and Those Who Did Not Participate