{
  "abstract": "Introduction Gastrointestinal cancer surgery commonly leads to postoperative complications and other adverse outcomes. While prehabilitation shows promise in reducing adverse postoperative outcomes, most hospitals have resource limitations that preclude its use as standard of care. Additionally, the need to expedite surgery from diagnosis often creates a narrow window for prehabilitation initiatives. Online, self-reported screening tools may address these challenges by facilitating early identification of high-risk patients and enabling targeted preoperative interventions, thereby allowing equitable allocation of limited resources. Therefore, the primary aim of this study is to evaluate the predictive utility of a tri-modal (physical, nutritional, psychological) screening tool for patients undergoing gastrointestinal cancer surgery.Methods This prospective international cohort study will recruit 1214 adults undergoing elective gastrointestinal cancer surgery across 35 sites from 19 countries. Participants will complete an online screening tool developed through a comprehensive, multistep, predefined process. The screening tool comprises the Duke Activity Status Index, Patient-Generated Subjective Global Assessment Short Form and the Patient Health Questionnaire-4, in English, Spanish, French or Portuguese. These tools were selected based on a scoping review, followed by an international Delphi consensus process. The primary outcomes include rate of postoperative complications, major complications (Clavien-Dindo Classification grade III–V) and overall complication severity assessed by the Comprehensive Complications Index; all assessed 30 days postoperatively. Secondary outcomes include hospital length of stay, readmission rate within 30 days, discharge destination (home vs other), days at home and alive in 30 days postsurgery, 30-day all-cause mortality and 12-month survival. Primary analyses will establish optimal screening tool cut-points to stratify patients into clinically actionable risk categories for postoperative complications and examine the independent predictive value of these screening scores after adjusting for established clinical risk factors.Ethics and dissemination This study has received ethical approval from the Sydney Local Health District Human Research and Ethics Committee (X25-0333 and 2025/ETH02465) and has been registered on the Open Science Framework (10.17605/OSF.IO/HVCGD). The results of Preoperative Risk Evaluation for Cancer Treatment will be submitted to reputable journals and presented at national and international conferences.",
  "authors": [
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia",
        "Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"
      ],
      "name": "Jack Reeves"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia",
        "Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"
      ],
      "name": "Cherry Koh"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Kate Alexander"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia",
        "Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"
      ],
      "name": "Michael Solomon"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Sascha Karunaratne"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Alexandria Petridis"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia",
        "Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"
      ],
      "name": "Sharon Carey"
    },
    {
      "affiliations": [
        "School of Psychology, Centre for Medical Psychology & Evidence-Based Decision Making, The University of Sydney Faculty of Science, Sydney, New South Wales, Australia"
      ],
      "name": "Haryana Dhillon"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Kate White"
    },
    {
      "affiliations": [
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia",
        "Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"
      ],
      "name": "Neil Pillinger"
    },
    {
      "affiliations": [
        "School of Human Nutrition, McGill University, Montreal, Québec, Canada"
      ],
      "name": "Chelsia Gillis"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Nicholas Hirst"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"
      ],
      "name": "Zaid Shadid"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"
      ],
      "name": "Md Ishraque Rahman"
    },
    {
      "affiliations": [
        "Physiotherapy Department, Launceston General Hospital, Launceston, Tasmania, Australia",
        "School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia"
      ],
      "name": "Ianthe Boden"
    },
    {
      "affiliations": [
        "Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia"
      ],
      "name": "Alison Mahoney"
    },
    {
      "affiliations": [
        "Department of Surgery and Critical Care, Dunedin Hospital, Dunedin, Otago, New Zealand"
      ],
      "name": "John Woodfield"
    },
    {
      "affiliations": [
        "General Surgical Department, Nepean Hospital, Penrith, New South Wales, Australia",
        "Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Daniel Vagg"
    },
    {
      "affiliations": [
        "Department of Anesthesiology Pain Medicine and Procedural Sedation and Analgesia, Martin General Hospital, Groningen, The Netherlands"
      ],
      "name": "Hans D De Boer"
    },
    {
      "affiliations": [
        "Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Paul Sutton"
    },
    {
      "affiliations": [
        "Postgraduate Program in Health Sciences, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Leani Pereira"
    },
    {
      "affiliations": [
        "Postgraduate Program in Health Sciences, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Ana Paula Drummond-Lage"
    },
    {
      "affiliations": [
        "Anaesthesia Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Santiago Mcloughlin"
    },
    {
      "affiliations": [
        "Anaesthesia Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Adrian Alvarez"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia"
      ],
      "name": "Katrina Pirie"
    },
    {
      "affiliations": [
        "Hepatobiliary and Upper Gastrointestinal Unit, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia",
        "Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Michael W Hii"
    },
    {
      "affiliations": [
        "Sudan Medical Specialisation Board, Department of General Surgery, Al-Waleedeen Specialised Hospital, Gezira State, Sudan"
      ],
      "name": "Alsadig Suliman"
    },
    {
      "affiliations": [
        "Department of General Surgery, University of Health Sciences Gülhane Training and Research Hospital, Ankara, Turkey"
      ],
      "name": "Burak Uçaner"
    },
    {
      "affiliations": [
        "First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece"
      ],
      "name": "Dimitrios Schizas"
    },
    {
      "affiliations": [
        "Intensive Care Medicine Department, Nasser Institute Hospital for Research and Treatment, Cairo, Egypt"
      ],
      "name": "Kyrillos Nassim"
    },
    {
      "affiliations": [
        "Department of General Surgery, Al Jumhuri Hospital, Sana’a, Yemen"
      ],
      "name": "Raga’a Albatool"
    },
    {
      "affiliations": [
        "Department of Surgery, Althawra Hospital, Sana’a, Yemen"
      ],
      "name": "Khloud Ali"
    },
    {
      "affiliations": [
        "Department of Propaedeutic Surgery, Hippocrateio Hospital of Athens, Athens, Greece"
      ],
      "name": "Tania Triantafyllou"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, General Hospital Saint George, Chania, Greece"
      ],
      "name": "Apostolaki Styliana"
    },
    {
      "affiliations": [
        "General Surgery Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy"
      ],
      "name": "Ilenia Merlini"
    },
    {
      "affiliations": [
        "Department of Gastrointestinal Surgery, University Hospital Ghent, Ghent, Belgium"
      ],
      "name": "Elke Van Daele"
    },
    {
      "affiliations": [
        "Department of General Surgery, General Hospital of Eastern Achaia, Agio, Greece"
      ],
      "name": "Francesk Mulita"
    },
    {
      "affiliations": [
        "Perioperative Medicine and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden"
      ],
      "name": "Max Bell"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain"
      ],
      "name": "Graciela Martinez-Palli"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany"
      ],
      "name": "Christian Koch"
    },
    {
      "affiliations": [
        "Division of Pancreatic and Transplant Surgery, San Raffaele Hospital, Milan, Italy"
      ],
      "name": "Massimo Falconi"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russian Federation"
      ],
      "name": "Tatiana Garmanova"
    },
    {
      "affiliations": [
        "Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia"
      ],
      "name": "Niantao Deng"
    },
    {
      "affiliations": [
        "Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario, Rome, Italy"
      ],
      "name": "Flavio Tirelli"
    },
    {
      "affiliations": [
        "Department of General Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands"
      ],
      "name": "Tim Lubbers"
    },
    {
      "affiliations": [
        "Hospital Universitario Austral, Buenos Aires, Argentina"
      ],
      "name": "Carina Chwat"
    },
    {
      "affiliations": [
        "British Hospital of Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Alfredo Costales"
    },
    {
      "affiliations": [
        "Department of Surgery, Southlake Regional Health Centre, Newmarket, Ontario, Canada"
      ],
      "name": "Nader M Hanna"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Andriana Petrova"
    },
    {
      "affiliations": [
        "Department of General Surgery, King Hussein Cancer Center, Amman, Jordan"
      ],
      "name": "Almu’atasim Khamees"
    },
    {
      "affiliations": [
        "NHMRC Clinical Trails Centre, The University of Sydney, Sydney, New South Wales, Australia",
        "RCS (Eng) Surgical Intervention Trials Unit (SITU-NDORMS), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "David Beard"
    },
    {
      "affiliations": [
        "Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia",
        "Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia"
      ],
      "name": "Catherine L Granger"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia",
        "Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia",
        "Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "School of Psychology, Centre for Medical Psychology & Evidence-Based Decision Making, The University of Sydney Faculty of Science, Sydney, New South Wales, Australia",
        "Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia",
        "School of Human Nutrition, McGill University, Montreal, Québec, Canada",
        "Physiotherapy Department, Launceston General Hospital, Launceston, Tasmania, Australia",
        "School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia",
        "Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia",
        "Department of Surgery and Critical Care, Dunedin Hospital, Dunedin, Otago, New Zealand",
        "General Surgical Department, Nepean Hospital, Penrith, New South Wales, Australia",
        "Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia",
        "Department of Anesthesiology Pain Medicine and Procedural Sedation and Analgesia, Martin General Hospital, Groningen, The Netherlands",
        "Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK",
        "Postgraduate Program in Health Sciences, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil",
        "Anaesthesia Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina",
        "Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia",
        "Hepatobiliary and Upper Gastrointestinal Unit, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia",
        "Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia",
        "Sudan Medical Specialisation Board, Department of General Surgery, Al-Waleedeen Specialised Hospital, Gezira State, Sudan",
        "Department of General Surgery, University of Health Sciences Gülhane Training and Research Hospital, Ankara, Turkey",
        "First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece",
        "Intensive Care Medicine Department, Nasser Institute Hospital for Research and Treatment, Cairo, Egypt",
        "Department of General Surgery, Al Jumhuri Hospital, Sana’a, Yemen",
        "Department of Surgery, Althawra Hospital, Sana’a, Yemen",
        "Department of Propaedeutic Surgery, Hippocrateio Hospital of Athens, Athens, Greece",
        "Department of Anesthesiology, General Hospital Saint George, Chania, Greece",
        "General Surgery Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy",
        "Department of Gastrointestinal Surgery, University Hospital Ghent, Ghent, Belgium",
        "Department of General Surgery, General Hospital of Eastern Achaia, Agio, Greece",
        "Perioperative Medicine and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden",
        "Department of Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain",
        "Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University Giessen, Giessen, Germany",
        "Division of Pancreatic and Transplant Surgery, San Raffaele Hospital, Milan, Italy",
        "Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russian Federation",
        "Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia",
        "Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario, Rome, Italy",
        "Department of General Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands",
        "Hospital Universitario Austral, Buenos Aires, Argentina",
        "British Hospital of Buenos Aires, Buenos Aires, Argentina",
        "Department of Surgery, Southlake Regional Health Centre, Newmarket, Ontario, Canada",
        "Barts Health NHS Trust, London, UK",
        "Department of General Surgery, King Hussein Cancer Center, Amman, Jordan",
        "NHMRC Clinical Trails Centre, The University of Sydney, Sydney, New South Wales, Australia",
        "RCS (Eng) Surgical Intervention Trials Unit (SITU-NDORMS), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK",
        "Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia",
        "Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Victoria, Australia"
      ],
      "name": "The PREdiCT Study Investigators"
    },
    {
      "affiliations": [
        "Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia",
        "NHMRC Clinical Trails Centre, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Daniel Steffens"
    }
  ],
  "title": "Preoperative Risk Evaluation for Cancer Treatment (PREdiCT): protocol for an international cohort study evaluating a trimodal screening tool to predict outcomes following gastrointestinal cancer surgery",
  "uid": "0791cd50-cfba-5c94-ba13-3a434c1ae94e"
}