Background: Multimodal prehabilitation (MPH) including medical and nutrition counseling and physical therapy improves outcomes after cancer surgery. However, the effects of MPH for IBD surgery are not established. We aimed to assess surgical outcomes among IBD patients exposed to MPH relative to no MPH. Methods: We conducted a case-controlled study among those exposed to MPH (cases) vs standard-of-care (SOC, controls) in patients with IBD who underwent major abdominal surgery for Crohn’s disease (CD) or ulcerative colitis (UC) between May 1, 2022 and October 31, 2023 at a tertiary care center. Cases were those who participated in a 10-week MPH program with medical and nutrition counseling (with guidance for preoperative carbohydrate loading (CL) and perioperative immunonutrition (IN)) and physical and mental health assessment and coaching, beginning 4 weeks prior to surgery; SOC included written preoperative surgical instructions without MPH. Baseline assessments for MPH included Patient-reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, Pain Interference, Global Mental and Physical Health, and General Health, Social Activities scales, 6-minute walk distance, timed get-up-and-go, fall risk status, and hand-grip strength. We assessed postoperative complications (defined by the comprehensive complications index (CCI)), post-operative length of stay (LOS), post-operative opioids (defined by daily morphine milligram equivalents (MME)), re-operation rate, 30-day readmission, and adherence to CL and PI. Statistical tests included linear and logistic regression, Mann-Whitney U test, Chi-Square test, and Fisher’s exact test. Results: A total of 77 patients were included, including 29 PH (cases) and 48 SOC (controls). Surgeries included ileocecal resection, colectomy with ileostomy, ileal pouch-anal anastomosis, and small bowel resection. Age, sex, was similar between groups. Postoperative complications and re-operation rates were significantly lower among MPH relative to SOC (Table). In the MPH group, lower complication rates were significantly associated with better baseline PROMIS Anxiety (p=0.021), Physical Health (p=0.006), and General Health scores (p=0.009), get-up-and-go times (p=0.014), absence of fall risk (p<0.001), and adherence to CL (p=0.036). Opioid use and LOS were numerically lower among MPH vs SOC, while 30d readmissions were numerically higher. In addition, shorter LOS was associated with better get-up-and-go times (p=0.031), absence of fall risk (p=0.010), and adherence to CL (p=0.041). Prior surgery, BMI, IN, and handgrip strength were not associated with outcomes. Conclusion: MPH may improve surgical outcomes in IBD. Larger, prospective, controlled studies may help to further clarify the impact of MPH on surgical outcomes for IBD.

Phillip Fleshner

Cedars-Sinai Medical Center

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