Authors (including presenting author) :
Tam KS1, Au TK1, Cheung HW1, Choi WW1, Fung YK1, So KY1, Tam WY2, Wong WS1, Yuen KY2
Affiliation :
(1)Physiotherapy Department, (2)Department of Surgery, Tseung Kwan O Hospital
Introduction :
ERAS is a worldwide trending evidence-based multidisciplinary perioperative management approach for patients undergoing major surgeries to reduce complications and enhance recovery. Colorectal cancer(CC), the commonest cancer, was chosen as the target group for ERAS since2016 at TKOH which is the first Hong Kong hospital implementing ERAS in a team-based approach. Physiotherapy plays an essential role in pre-operative risk stratification, pre-habilitation and early mobilization which are key components of ERAS recommendations.
Objectives :
To review physiotherapy service in ERAS for CC patients
Methodology :
Pre-operative Risk Stratification CC patients scheduled for surgery were referred for assessment of respiratory condition, functional capacity with six-minute-walk-test(6MWT) and handgrip strength(HGS). Patients with 6MWT distance ≤350meters or ≤400meters, HGS below normative data and comorbidities were triaged as high-risk or moderate-risk group respectively. Pre-habilitation Both high and moderate-risk patients were prescribed with individualized aerobic and strengthening exercise to optimize physical fitness pre-operatively. With further enhancement, supervised physical conditioning at outpatient started since August 2019. Post-operative Phase Chest physiotherapy and early graded mobilization started on post-operative day(POD)1. Patient management plans were discussed during multidisciplinary-ward-rounds. Patients’ Satisfaction Patient satisfaction was evaluated after completion of program. The evaluation included understanding of ERAS approach, role of therapeutic exercise and effectiveness of the program.
Result & Outcome :
From February 2016 to November 2019, 422 patients participated in the program. The mean age was 67.1, and 63.3% was males. Average pre-habilitation period was 28days. 108 and 58patients were triaged as high and moderate-risk group respectively. The median length of stay(LOS) was shortened from 9 to 6.5days, and the post-operative complication rate was reduced from 37.3% to 22.2%. compared with that before ERAS implementation. 99% of patients mobilized out of bed on POD1-2 without adverse events occurred. All patients reported they fully understood the purpose of pre- and post-operative education, allowing them to be physically well prepared for surgery, and pre-habilitation exercise enhanced their post-operative recovery. Conclusions Enhanced role of physiotherapy in ERAS for CC surgery is effective in enhancing recovery through identifying patients at risk, changing cultural belief and engaging participation in the whole pathway. Our review showed ERAS is effective for CC patients and we are expanding our services to orthopaedics and gynaecology.
