{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:31:44Z","timestamp":1790573504827,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Preoperative optimization has emerged as a critical strategy in enhancing surgical outcomes, particularly for oncological patients. By addressing modifiable risk factors before surgery, healthcare providers aim to improve postoperative outcomes. The aim of this study was to evaluate the impact of a preoperative optimization program on postoperative outcomes and improvements in modifiable risk factors (anemia, malnutrition, smoking, and endocrine management) among oncology patients undergoing elective surgery. Methods: A retrospective pretest\u2013posttest study was conducted including all oncology patients who underwent elective general surgery at King Hussein Cancer Center between January 2020 and December 2021. The preoperative optimization program was launched in May 2020 and fully implemented by December 2020. Program elements included anemia management, nutritional support, smoking cessation, and glycemic control. Patients were divided into pre-implementation and post-implementation cohorts, and outcomes were assessed at baseline, immediately preoperatively, and 30 days postoperatively. Results: The sample included 503 individuals, 53.9% had preoperative anemia, 15.5% had malnutrition, 40.6% were smokers, and 41.6% had uncontrolled DM. The optimized group demonstrated significant improvements in hemoglobin, albumin, and smoking cessation rates. In contrast, the control group showed worsening hemoglobin and albumin levels over the same period. Serious complications (Clavien\u2013Dindo III\u2013IV) were significantly more frequent in the control group (p = 0.006). The likelihood of postoperative complications among the control group was significantly higher than the optimized group (OR: 2.2, 95%CI: 1.5\u20133.2, p &lt; 0.001). Conclusions: Implementation of a comprehensive preoperative optimization program significantly improved modifiable risk factors and reduced serious postoperative complications, highlighting its value for adoption in oncology surgical care.<\/jats:p>","DOI":"10.3390\/jcm14217820","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T12:13:08Z","timestamp":1762258388000},"page":"7820","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Impact of Multidisciplinary Preoperative Optimization Program on Postoperative Outcomes Among Surgical Oncology Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4846-4432","authenticated-orcid":false,"given":"Yasmin","family":"Safi","sequence":"first","affiliation":[{"name":"Department of Surgery, King Hussein Cancer Center, Amman 11941, Jordan"},{"name":"Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2345-4892","authenticated-orcid":false,"given":"Mohammad S.","family":"Alyahya","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihaya A.","family":"Al-sheyab","sequence":"additional","affiliation":[{"name":"Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Suliman","sequence":"additional","affiliation":[{"name":"Community and Mental Health Department, School of Nursing, Al Al-Bayt University, Mafraq 25113, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Al-Masri","sequence":"additional","affiliation":[{"name":"Department of Surgery, King Hussein Cancer Center, Amman 11941, Jordan"},{"name":"Department of Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"ref_1","first-page":"7","article-title":"Cancer Statistics, 2021","volume":"71","author":"Siegel","year":"2021","journal-title":"CA A Cancer J. Clin."},{"key":"ref_2","unstructured":"World Health Organization (WHO) (2025, May 01). Cancer. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cancer."},{"key":"ref_3","unstructured":"Ministry of Health Non-Communicable Diseases Directorate Jordan Cancer Registry (2019). Cancer Incidence in Jordan."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Shahzad, H.N. (2018). An Overview of Cancer Treatment Modalities. Neoplasm, IntechOpen.","DOI":"10.5772\/intechopen.69560"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/SLA.0000000000002851","article-title":"Increased Healthcare Utilization for Medical Comorbidities Prior to Surgery Improves Postoperative Outcomes","volume":"271","author":"Leeds","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_6","first-page":"40","article-title":"Postoperative Complications and Clinical Outcomes among Patients Undergoing Thoracic and Gastrointestinal Cancer Surgery: A Prospective Cohort Study","volume":"28","year":"2016","journal-title":"Rev. Bras. Ter. Intensiv."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Dencker, E.E., Bonde, A., Troelsen, A., Varadarajan, K.M., and Sillesen, M. (2021). Postoperative Complications: An Observational Study of Trends in the United States from 2012 to 2018. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01392-z"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.amsu.2020.04.024","article-title":"Surgical Complications in Colorectal Cancer Patients","volume":"55","author":"Pak","year":"2020","journal-title":"Ann. Med. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jss.2016.06.073","article-title":"Incidence and Significance of Postoperative Complications Occurring between Discharge and 30 Days: A Prospective Cohort Study","volume":"206","author":"Woodfield","year":"2016","journal-title":"J. Surg. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1213\/ANE.0000000000004571","article-title":"Roadmap for Transforming Preoperative Assessment to Preoperative Optimization","volume":"130","author":"Aronson","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_11","unstructured":"Varghese, T.K., Chishimba, S., Ma, M., Ko, C.Y., and Flum, D.R. (2019). The ACS Strong for Surgery Program: Changing Clinician and System Behavior to Optimize Health Before Surgery, ACS Bulletin. Available online: https:\/\/www.facs.org\/for-medical-professionals\/news-publications\/news-and-articles\/bulletin\/2019\/10\/the-acs-strong-for-surgery-program-changing-clinician-and-system-behavior-to-optimize-health-before-surgery\/."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1177\/1098214010369170","article-title":"Insight Into Evaluation Practice: A Content Analysis of Designs and Methods Used in Evaluation Studies Published in North American Evaluation-Focused Journals","volume":"31","author":"Christie","year":"2010","journal-title":"Am. J. Eval."},{"key":"ref_13","unstructured":"Young, J. (2016). Retrospective Pre\/Posttest Design and Response-Shift Bias in an Urban After-School Program for Teens: A Mixed Methods Study. [Ph.D. Thesis, Loyola University Chicago]. Available online: https:\/\/ecommons.luc.edu\/luc_diss\/2156."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"29","DOI":"10.21037\/dmr-20-48","article-title":"Pre-Optimisation of the Cancer Patient","volume":"3","author":"Robson","year":"2020","journal-title":"Dig. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/ACO.0b013e32834ef903","article-title":"Preoperative Optimization: Rationale and Process: Is It Economic Sense?","volume":"25","author":"Snowden","year":"2012","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/asj-23-41","article-title":"Innovative Approaches to Preoperative Care Including Feasibility, Efficacy, and Ethical Implications: A Narrative Review","volume":"4","author":"Vine","year":"2024","journal-title":"AME Surg. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S537","DOI":"10.21037\/jtd.2019.01.06","article-title":"Optimizing Health before Elective Thoracic Surgery: Systematic Review of Modifiable Risk Factors and Opportunities for Health Services Research","volume":"11","author":"Stokes","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1177\/15563316211030923","article-title":"Preoperative Patient Optimization in Total Joint Arthroplasty\u2014The Paradigm Shift from Preoperative Clearance: A Narrative Review","volume":"18","author":"MacMahon","year":"2022","journal-title":"HSS J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/S0140-6736(11)61381-0","article-title":"Preoperative Anaemia and Postoperative Outcomes in Non-Cardiac Surgery: A Retrospective Cohort Study","volume":"378","author":"Musallam","year":"2011","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Yan, T., Lei, S., Zhou, B., Huang, Y., Li, X., Zhang, J., Huang, Q., and Zhang, L. (2023). Association between Preoperative Anemia and Postoperative Short-Term Outcomes in Patients Undergoing Colorectal Cancer Surgery\u2014A Propensity Score Matched Retrospective Cohort Study. BMC Anesthesiol., 23.","DOI":"10.1186\/s12871-023-02270-2"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"373","DOI":"10.4048\/jbc.2012.15.4.373","article-title":"Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades","volume":"15","author":"Srivastava","year":"2012","journal-title":"J. Breast Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017","volume":"152","author":"Umscheid","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/PRS.0000000000002958","article-title":"The Association between Smoking and Plastic Surgery Outcomes in 40,465 Patients: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Sets","volume":"139","author":"Goltsman","year":"2017","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"zrad016","DOI":"10.1093\/bjsopen\/zrad016","article-title":"Smoking Is a Predictor of Complications in All Types of Surgery: A Machine Learning-Based Big Data Study","volume":"7","author":"Reito","year":"2023","journal-title":"BJS Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1001\/jamasurg.2016.5704","article-title":"Association between Smoking Status, Preoperative Exhaled Carbon Monoxide Levels, and Postoperative Surgical Site Infection in Patients Undergoing Elective Surgery","volume":"152","author":"Nolan","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"645","DOI":"10.12968\/jowc.2019.28.10.645","article-title":"Surgical Wound Complications: A 21st Century Problem?","volume":"28","year":"2019","journal-title":"J. Wound Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1001\/archsurg.2012.5","article-title":"The Clinical Impact of Smoking and Smoking Cessation: A Systematic Rivew and Meta-Analysis","volume":"147","year":"2012","journal-title":"Arch. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e029913","DOI":"10.1136\/bmjopen-2019-029913","article-title":"Effects of Active Smoking on Postoperative Outcomes in Hospitalised Patients Undergoing Elective Surgery: A Retrospective Analysis of an Administrative Claims Database in Japan","volume":"9","author":"Yoshikawa","year":"2019","journal-title":"BMJ Open"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1007\/s00423-022-02486-9","article-title":"Impact of Preoperative Smoking on Patients Undergoing Right Hemicolectomies for Colon Cancer","volume":"407","author":"Badiani","year":"2022","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/iwj.13887","article-title":"Smoking Increases the Risk of Postoperative Wound Complications: A Propensity Score-Matched Cohort Study","volume":"20","author":"Lee","year":"2023","journal-title":"Int. Wound J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e15089","DOI":"10.1097\/MD.0000000000015089","article-title":"Postoperative Adverse Events in Patients with Diabetes Undergoing Orthopedic and General Surgery","volume":"98","author":"Wang","year":"2019","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4097\/kja.21295","article-title":"The Impact of Preoperative Glycated Hemoglobin (HbA1c) on Postoperative Complications after Elective Major Abdominal Surgery: A Meta-Analysis","volume":"75","author":"Wong","year":"2022","journal-title":"Korean J. Anesthesiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e341","DOI":"10.1016\/S2214-109X(22)00550-2","article-title":"Impact of Malnutrition on Early Outcomes after Cancer Surgery: An International, Multicentre, Prospective Cohort Study","volume":"11","author":"Riad","year":"2023","journal-title":"Lancet Glob. 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