BJS01 Propensity score analysis of prognostic benefit of prehabilitation in Upper Gastro-Intestinal cancer surgery

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Abstract Background Risk profile assessment by prehabilitation (prehab) is an important emerging policy in patients with suspected cancer. This study aimed to determine the value of prehab at index consultation in Upper Gastro-Intestinal (UGI) cancer with the hypothesis that prehab would improve outcomes. Methods Consecutive 907 patients were studied prospectively (182 receiving prehab) and outcomes were compared with historical controls, incorporating a propensity score analysis. Primary outcomes were operative morbidity, mortality, Length of Hospital Stay (LoHS), clinical effectiveness related to Quality-Adjusted Life Years (QALYs) to price a treatment’s cost-effectiveness and Overall Survival (OS). Results After regression for confounding factors, a cohort of 907 patients was available, with 182 receiving prehab (median age 67 y, 128 Oesophageal (OC), 54 Gastric Cancer (GC)) and 725 control therapy [67 y, 410 OC, 315 GC]. Prehab operative morbidity (Clavien-Dindo ³ 3) and mortality were 18.1 and 1.6% vs. 20.4 (p=0.215) and 2.5% (p=0.484) in controls and median LoHS 11 vs. 13 days (p=0.007). Two-year OS after prehab was 67.9 vs. 59.1% in controls (p=0.027). Multivariable analysis revealed that prehab (HR 0.647, p=0.026), positive resection margin (HR 1.345, p=0.036), peri-operative Acute Kidney Injury (HR 2.645, p<0.001) and pTNM stage; stage II (HR 2.159, p=0.037), stage III (HR 4.234, p<0.001) and stage IV (HR 5.892, p<0.001), were associated with OS. The cost per QALY for OC was £8,851 and GC £7,614. Conclusion Prehab was associated with two-day shorter LoHS and 9% better OS, supporting the hypothesis that prehab is an important cost-effective strategy related to NICE guidance.

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