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. 2022 Jul 29:12:958261.
doi: 10.3389/fonc.2022.958261. eCollection 2022.

The effect of prehabilitation on the postoperative outcomes of patients undergoing colorectal surgery: A systematic review and meta-analysis

Xiaoting Zhang  1 , Shaokang Wang  2 , Wentao Ji  1 , Huixian Wang  1 , Keqian Zhou  3 , Zhichao Jin  4 , Lulong Bo  1
Affiliations

The effect of prehabilitation on the postoperative outcomes of patients undergoing colorectal surgery: A systematic review and meta-analysis

Xiaoting Zhang et al. Front Oncol. .

Abstract

Study objective: Prehabilitation is analogous to marathon training and includes preoperative preparation for exercise, as well as nutrition and psychology. However, evidence-based recommendations to guide prehabilitation before colorectal surgery are limited. We aimed to evaluate the effect of prehabilitation on the postoperative outcomes of patients undergoing colorectal surgery.

Design: This study is a systematic review and meta-analysis.

Methods: The PubMed, Embase, and Cochrane databases were searched for studies reporting the effect of prehabilitation strategies versus standard care or rehabilitation in patients undergoing colorectal surgery. The primary outcomes were overall postoperative complications and length of hospital stay (LOS), and the secondary outcome was functional capacity (measured using the 6-min walk test [6MWT]) at 4 and 8 weeks after surgery.

Main results: Fifteen studies with 1,306 participants were included in this meta-analysis. The results showed no significant reduction in the number of overall postoperative complications (risk ratio = 1.02; 95% confidence interval [CI] = 0.79-1.31; p = 0.878) or LOS (standardized mean difference = 0.04; 95% CI = -0.11 to 0.20; p = 0.589) in patients who underwent colorectal surgery with or without prehabilitation strategy. Additionally, there were no significant differences in the functional capacity estimated using the 6MWT at 4 and 8 weeks postoperatively.

Conclusions: Prehabilitation did not significantly affect the number of postoperative complications, LOS, or functional capacity of patients undergoing colorectal surgery. Whether prehabilitation should be recommended deserves further consideration.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290108, identifier CRD42021290108.

Keywords: colorectal surgery; complications; functional capacity; meta-analysis; prehabilitation; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the selection and inclusion process.
Figure 2
Figure 2
Forest plot for overall complications after colorectal surgery with or without preoperative prehabilitation strategies.
Figure 3
Figure 3
Trial sequential analysis for overall complications after colorectal surgery with or without preoperative prehabilitation strategies. The blue z-curve was drawn by applying a random-effects model.
Figure 4
Figure 4
Forest plot for the length of hospital stay after colorectal surgery with or without preoperative prehabilitation strategies.
See this image and copyright information in PMC

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