{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:39:31Z","timestamp":1792795171055,"version":"4.5.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"\n Importance<\/jats:title>\n Surgical resection is the cornerstone of curative treatment for colorectal cancer but can be associated with postoperative morbidity. Multimodal prehabilitation may improve preoperative fitness; its effect remains unclear because small sample sizes, heterogeneity, and selective populations have limited prior studies, highlighting the need for real-world evidence.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the effectiveness of a multimodal prehabilitation program in unselected patients undergoing colorectal cancer resection.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this multicenter cohort study, patients undergoing colorectal cancer surgery who participated in a multimodal prehabilitation program were compared with historical controls from the same centers using propensity score matching accounting for age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, surgical procedure, and operative approach. A total of 18 hospitals in the Netherlands participated in a nationwide implementation between 2020 and 2023. All adults who underwent elective colorectal cancer resection were eligible. Study data were analyzed from June 2014 to June 2023 for the control group and from April 2020 to June 2023 for the prehabilitation group.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n The program included high-intensity exercise 3 times per week, nutritional support, psychological counseling, and optimization of comorbidities including anemia, frailty management, and smoking cessation when indicated.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcome parameters were overall, medical, and surgical complications, length of hospital stay, and rates of readmission and intensive care admissions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In total, 2384 patients were included (mean [SD] age, 70 [11] years; 1254 male [53%]; 1192 patients per group). Overall complication rates were lower in the prehabilitation group (356 of 1181 [30.1%] vs 446 of 1181 [37.8%]; odds ratio [OR], 0.71; 95% CI, 0.60-0.84) as were medical complications (182 of 1181 [15.4%] vs 290 of 1181 [24.6%]; OR, 0.56; 95% CI, 0.46-0.69) and surgical complications (253 of 1181 [21.4%] vs 294 of 1181 [24.9%]; OR, 0.82; 95% CI, 0.68-1.00). Median (IQR) length of hospital stay was 1 day shorter (4 [3-6] days vs 5 [4-8] days;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), whereas rates of readmission and intensive care admission were reduced. Reduction in complication rates in the prehabilitation cohort occurred irrespective of age and ASA score.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Results of this cohort study show that implementation of a uniform multimodal prehabilitation program for unselected patients undergoing colorectal cancer surgery was associated with reduced complication rates and length of hospital stay across all age and ASA score subgroups.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.1519","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:30:22Z","timestamp":1779291022000},"page":"711","source":"Crossref","is-referenced-by-count":7,"title":["Nationwide Implementation of Multimodal Prehabilitation and Complications After Colorectal Cancer Surgery"],"prefix":"10.1001","volume":"161","author":[{"given":"Charissa R.","family":"Sabajo","sequence":"first","affiliation":[{"name":"Department of Surgery, M\u00e1xima Medical Center, Eindhoven, the Netherlands"},{"name":"Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W. G.","family":"ten Cate","sequence":"additional","affiliation":[{"name":"Department of Surgery, M\u00e1xima Medical Center, Eindhoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"van Grinsven","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Rijnstate Hospital, Arnhem, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lennaert C. B.","family":"Groen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiel G. G.","family":"Verdaasdonk","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jeroen Bosch Hospital, \u2018s-Hertogenbosch, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne C. L.","family":"Kerstens","sequence":"additional","affiliation":[{"name":"Depertment of Rehabilitation, Bravis Hospital, Roosendaal, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jalou J. M.","family":"Woltering","sequence":"additional","affiliation":[{"name":"Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik A.","family":"Marsman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruud F. W.","family":"Franssen","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiotherapy, VieCuri Medical Center, Venlo, the Netherlands"},{"name":"Department of Epidemiology, GROW Research Institute for Oncology & Reproduction, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ad","family":"Kerst","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Physiotherapy Science & Sports, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernst J. A.","family":"Steller","sequence":"additional","affiliation":[{"name":"Department of Surgery, Isala, Zwolle, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okan W.","family":"Bastian","sequence":"additional","affiliation":[{"name":"Department of Surgery, Beatrixziekenhuis (Rivas), Gorinchem, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casper D. P.","family":"van \u2019t Hullenaar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Van Weel-Bethesda Hospital, Dirksland, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaldert K.","family":"Talsma","sequence":"additional","affiliation":[{"name":"Department of Surgery, Deventer Ziekenhuis, Deventer, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wout","family":"van der Meij","sequence":"additional","affiliation":[{"name":"Department of Surgery, Bernhoven Hospital, Uden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"Inberg","sequence":"additional","affiliation":[{"name":"Department of Surgery, Regional hospital Koningin Beatrix, Winterswijk, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geertruid M. 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