Preoperative Respiratory Muscle Training Is Associated With Reduced Hospital Length of Stay After CRS/HIPEC: A Matched Retrospective Cohort Study

Purpose: Cytoreduction and heated intraperitoneal chemotherapy is the standard of care for selected patients with peritoneal malignancies. By nature, these procedures are maximally invasive and are associated with high rates of postoperative complications and prolonged hospital stay. Although preoperative prehabilitation with respiratory muscle training (RMT) has demonstrated benefits in various surgical populations, its impact in patients undergoing CRS/HIPEC remains understudied. Methods: We conducted a retrospective review of a prospectively maintained database at a high-volume CRS/HIPEC center. Patients scheduled for CRS/HIPEC who received a preoperative prehabilitation program with RMT were identified and matched 2:1 to control patients based on (age, completion of cytoreduction, primary site, and year of CRS/HIPEC). Univariable comparisons were performed using chi-squared and Kruskal–Wallis tests. Multivariable linear regression was used to assess the association of prehabilitation on hospital length of stay (LOS), adjusting for age, grade 3 to 5 complication, and receipt of prehabilitation. Kaplan–Meier survival analysis was conducted to explore differences in overall survival. Results: A total of 38 patients who underwent curative intent CRS/HIPEC during the study period received preoperative prehabilitation with RMT. After matching, 98 patients were included in the final analysis, with 38.8% (38/98) receiving prehabilitation. There were no significant differences in demographics or rates of postoperative complications, including pulmonary complications, between groups. Median LOS was significantly shorter in the prehabilitation group (8 days [IQR 7–8]) compared with controls (9 days [interquartile range (interquartile ranges) 7.5–12]; P = .002). Multivariable regression showed prehabilitation was associated with a 2.8-day reduction in LOS ( P = .01). No significant difference in overall survival was observed (156.0 vs 57.0 months; P = .097). Conclusions: Preoperative prehabilitation with RMT in patients undergoing CRS/HIPEC is feasible and associated with reduced hospital length of stay. Although no significant differences were observed in postoperative complications or survival rates, these suggest a potential role for prehabilitation in optimizing perioperative recovery reducing health care utilization in this high-risk population.