Multimodal Prehabilitation for Colorectal Cancer Patients: Study Protocol of a Nationwide Multicentre Study With Uniform Prehabilitation Protocols.

Background: The aim of prehabilitation is to optimize patient specific modifiable risk factors before major surgery, in order to enhance the individual resilience. Due to the lack of universal guidelines, prehabilitation has been conducted in various ways, making it difficult to estimate its effect. In the Netherlands, proposed uniform prehabilitation protocols were developed. The aim of this study is to analyse clinical outcomes of prehabilitation when implemented as standard of care according to the proposed uniform protocols.

Methods: Uniform prehabilitation protocols were created based on the multimodal program of the PREHAB randomized controlled trial. All hospitals in the Netherlands that implemented prehabilitation according to the proposed protocols, for patients undergoing elective colorectal surgery, will be asked to participate. This study will recruit 535 patients who underwent prehabilitation and 535 one-to-one nearest neighbour propensity score matched patients who did not undergo prehabilitation (historical cohort). Clinical outcomes will be compared between the prehabilitation group and the historical cohort group using regression analyses. The primary outcome of interest is 90-day presence of postoperative complications. In addition, length of hospital stay and readmissions will be analysed.

Discussion: Prehabilitation has been proven to reduce the risk of complications and hospital length of stay. Prehabilitation has however been defined in various ways, since there is no standardized program. This multicentre cohort study will estimate the clinical effect of prehabilitation implemented as standard of care according to proposed uniform protocols. Furthermore, the presented protocols can be used by other hospitals to set up a prehabilitation program.