Abstract
Esophagectomy often leads to long recoveries. Prehabilitation programs aim to improve postoperative outcomes, particularly in complex surgeries like esophagectomy. This study evaluates the implementation of a structured prehabilitation program, the Thoracic Surgery Optimization Program (TOP), on outcomes for esophagectomy patients. A retrospective study was performed of all patients that underwent esophagectomy from 2022-2024. Patients were divided into two groups: the "No TOP" group (before TOP implementation, 01/2022-10/2023) and the "TOP" group (after TOP implementation, 11/2023-06/2024). Variables analyzed included compliance with program components, G8 Frailty scores, and postoperative outcomes such as LOS, ICU LOS, complications, and time to adjuvant therapy. There were 71 esophagectomies included, mean age 69 yo with 39 (54.9%) in the No TOP group and 32 (45.1%) in the TOP group.
After TOP implementation, G8 frailty assessments identified 71.9% of patients as frail with a mean frailty score 11. TOP participants showed good compliance with the prehabilitation program components with 84.4% compliant with physical therapy, 87.5% compliant with nutrition, and 62.5% with the overall program. There were no significant differences in complication or readmission rates between group. 62.5% of the TOP group ambulated POD1. Patients in the TOP group had significantly shorter ICU LOS (1.9 vs. 5.7 days, p=0.003). The TOP program improved postoperative recovery, with shorter ICU stays and early mobility. High compliance rates suggest that implementation of a structured prehabilitation program is feasible, even for frail patients, and has the potential to improve postoperative outcomes without adding risk.