Colorectal Surgery

Trimodal prehabilitation improves preoperative fitness but not short-term morbidity overall.

In this prospective single-center cohort (244 analyzed), a 3–6 week trimodal prehabilitation plus ERAS improved preoperative 6-minute walk distance and FVC versus ERAS alone. There were no differences in overall 7- or 30-day morbidity, severe morbidity, 30-day readmission, mortality, or length of stay between groups. Exploratory subgroup analyses suggested CT-defined myosteatosis identified higher-risk patients who had lower 7-day morbidity with prehabilitation (p = 0.045). Prehabilitation gains waned by 8 weeks, so benefits appear short-term and may justify targeting rather than routine use for all patients. 1

Red ginseng postoperatively preserved microbiome diversity and raised Lactobacillus and albumin.

In this randomized trial of GI cancer surgery patients (60 enrolled; 16 red ginseng, 25 control analyzed), postoperative alpha diversity fell in controls but remained relatively stable with red ginseng. Red ginseng markedly increased Lactobacillus abundance postoperatively (18.34% vs 0.23%, p < 0.001) and was associated with higher serum albumin at 3 months (p = 0.003). Global health status/QOL scores improved with red ginseng (p = 0.047). Small final sample and incomplete reporting limit generalizability; consider these results hypothesis-generating rather than practice-changing. 2

Pediatric ERP implementation improved some process measures; fidelity mattered for outcomes.

In a stepped-wedge trial of 597 patients aged 10–18 across 18 U.S. sites, overall postoperative length of stay did not differ by study phase. Patients receiving at least 13 ERP elements had shorter median LOS (−1.14 days) and fewer complications (adjusted OR 0.48, 95% CI 0.28–0.82). Time to regular diet shortened and inpatient opioid use decreased during implementation phases. Site-level ERP integration and culture correlated with fidelity, highlighting implementation rather than protocol content as key to benefit. 3