Correlation Between Physical Status Measures And Frailty Score In Patients Undergoing Pancreatic Resection
*Breanna C Perlmutter, *Julie Ali, *Turgut B Cengiz, *Toms Augustin, *Daniel Joyce, *Robert Simon, R. Matthew Walsh
Cleveland Clinic, Cleveland, OH
OBJECTIVE(S): Data from the implementation of a pre-operative prehabilitation program in a pancreatic resection-specific cohort are lacking. This study aimed to assess the correlation between validated physical status measures used in a prehabilitation regimen with an established frailty score and analyze changes in these measures following completion of a directed prehabilitation program.
METHODS: Adult patients undergoing pancreatic resection at an academic center from 2019-2021 were enrolled in a pilot prehabilitation program. Three validated measures of physical status were recorded before and after completion of the program: the 6 minute walk test (6MWT), grip strength (GS), and chair-stand test (CST). The prehabilitation program comprised a goal of 7,500 steps, 30 grip strength exercises, and 100 chair-stand exercises daily and optional immuno-nutrition supplements. Patientsí frailty score was calculated using the Modified Johns Hopkins Frailty score. Changes in physical status measures before and after prehabilitation were compared using paired two sample t-tests.
RESULTS: Thirty-two patients with a median age of 69.0 years (IQR= 59.5-76.3 years) and 12 (37.5%) females were included. Patientsí median duration of participation was 21.5 days (IQR= 16-29 days). There was a negative correlation between increasing frailty score and baseline 6MWT (R2=0.17, Figure 1) and CST (R2=0.18, Figure 1). Patientsí mean 6MWT distance decreased at the end of the prehabilitation program (380.1 m v. 327.7 m, pre v. post, respectively, p<0.001), GS was unchanged (30.9 kg v. 29.4 kg, pre v. post, respectively, p=0.10), and the mean number of chair-stands was unchanged (9.6 v. 10.8, pre v. post, respectively, p=0.09). When stratified by low/intermediate (0-2) and high (≥3) frailty scores, the post-prehabilitation differences in 6MWT and CST were unchanged.
CONCLUSIONS: The correlation of physical status measures with frailty score suggests surgeonsí use of only one of these measures may be sufficient to estimate patientsí pre-operative physical status. The lack of improvement in patientsí physical status measures following prehabilitation suggests the importance of an expedited operation or the need for a more comprehensive prehabilitation program.
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