Dr Daniel Steffens

Dr Daniel Steffens is the Deputy Director of the Surgical Outcomes Research Centre (SOuRCe) at the Royal Prince Alfred Hospital, and a Clinical Senior Lecturer at the Sydney Medical School, The University of Sydney. Dr Steffens completed a first class honours degree in physiotherapy and was awarded his PhD from The University of Sydney in June 2015. Dr Steffens has over 10 years of experience in large-scale clinical studies having worked on the NHMRC-funded PACE trial (N=1650) as a clinical research assistant and completed the NHMRC-funded TRIGGERS study (n=1000) as part of his PhD. Dr Steffens is currently managing 10 research officers involved in the running of over 50 surgical research studies, including 10 surgical RCTs.

Abstract

Feasibility and acceptability of pre-operative exercise to improve patient outcomes after major cancer surgery

Background:
Survival outcomes for patients undergoing major abdominal cancer surgery are now acceptable, however, the high rate of postoperative complications remains a challenge. Currently, there is some evidence suggesting that preoperative exercise may reduce postoperative complications. The primary aim of this pilot trial was to establish the feasibility and acceptability of a preoperative exercise program designed to improve patient outcomes after cytoreductive surgery and pelvic exenteration. The secondary aim was to obtain pilot data on the likely difference in key surgical outcomes to inform the sample size calculation for a full-scale randomised controlled trial.

Methods:
Patients scheduled to undergo pelvic exenteration or cytoreductive surgery were invited to participate. Participants were randomised (1:1 ratio) to a 2-6 weeks preoperative, face-to-face, individualised exercise program (intervention group) or to usual care (control group). Feasibility was assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the preoperative exercise program. Acceptability of the exercise program was assessed with a semi-structured questionnaire. In addition, postoperative complication rates, length of hospital stay and quality of life measures were collected at baseline, day before surgery and in-hospital.

Results:
Of 122 patients screened, 26 (21%) were eligible and 22 (85%) accepted to participate in the trial and were randomised to the intervention (11; 50%) or control group (11; 50%). No difference in baseline characteristics were found, with most patients being male (55%) and presenting a median age of 63 years, with 11 (50%) undergoing pelvic exenteration. All participants completed the trial with no crossovers. Adherence to the preoperative exercise sessions was 92.7%, with all participants either satisfied (33%) or extremely satisfied (67%) with the overall design of the preoperative exercise program. No significant differences in postoperative complication rates, length of hospital stay and pre-discharge quality of life outcomes was found between groups. 

Conclusions:
The results of our pilot trial demonstrate that a preoperative exercise program is feasible and acceptable to patients undergoing major abdominal cancer surgery. There is an urgent need for a definite trial investigating the effectiveness of a preoperative exercise program on postoperative outcomes in patients undergoing major abdominal cancer surgery.