Impact of the Thoracic Surgery Optimization Program on Postoperative Recovery in Esophagectomy Patients

Abstract

Background: Esophagectomy is associated with an extended clinical course and a challenging, prolonged recovery. Prehabilitation programs aim to improve postoperative outcomes, particularly in complex surgeries like esophagectomy. This study evaluates the implementation and feasibility of the Thoracic Surgery Optimization Program (TOP), for esophagectomy patients. Methods: A retrospective study was performed of all patients that underwent esophagectomy from 2022 to 2024. Patients were divided into two groups: the “No TOP” group (before TOP, 01/2022-10/2023) and the “TOP” group (after TOP, 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. Results: There were 71 esophagectomies included, mean age 69 years old with 39 (54.9%) in the No TOP group and 32 (45.1%) in the TOP group. After the implementation of TOP, frailty assessments identified 71.9% of patients as frail with a median frailty score 11. TOP participants demonstrated good compliance with the prehabilitation program components with % compliance with physical therapy, 87.5% compliance with nutrition, and 62.5% compliance with the overall program. There were no significant differences in complication or readmission rates between groups. 62.5% of the TOP group ambulated on POD1. Patients in the TOP group had shorter ICU LOS (1.9 vs 5.7 days, P = .003), however, no significant differences were observed in total hospital length of stay, postoperative complications, or readmissions. Conclusion: Implementation of the TOP was feasible with good participation in multidisciplinary prehabilitation among patients undergoing esophagectomy, including those identified as frail. Although shorter ICU stays and more frequent POD1 ambulation were observed after implementation, the retrospective before-and-after design and potential for temporal and care-process confounding prevent attribution of these differences to TOP. A substantial effect on overall postoperative recovery was not established.