A systematic review and meta-analysis of high-quality randomized controlled trials on the role of prehabilitation programs in colorectal surgery
Zoe Garoufalia, Sameh Hany Emile, Sarinya Meknarit, Rachel Gefen, Nir Horesh, Peige Zhou, Pauline Aeschbacher, Victor Strassmann, Steven D. Wexner
Abstract
<h2>Abstract</h2><h3>Background</h3> Prehabilitation is gaining popularity in colorectal surgery but lacks high-quality postoperative outcomes data. This meta-analysis explored whether prehabilitation impacts postoperative outcomes. <h3>Methods</h3> In this meta-analysis, compliant with Preferred Reporting Items for Systematic reviews and Meta-Analyses, we searched PubMed and Scopus through November 2022. High-quality randomized control trials involving adults who underwent colorectal surgery with/without exercise-based prehabilitation were included. The main outcomes were short-term postoperative morbidity, readmissions, and length of stay. Random-effect meta-analyses were performed, and statistical heterogeneity was assessed using the <i>I</i><sup>2</sup> statistic. <h3>Results</h3> Seven high-quality randomized control trials comprising 1,225 patients were included. The median prehabilitation duration was 4 (2–4) weeks. Four studies compared prehabilitation and standard of care, and 3 compared prehabilitation and rehabilitation. Exercise-based prehabilitation did not reduce the odds of short-term complications (odds ratio 0.62, 95% confidence interval 0.27–1.40, <i>P</i> = .25, <i>I</i><sup>2</sup> = 68%) or readmission (odds ratio 1, 95% confidence interval 0.73–1.46, <i>P</i> = .85, <i>I</i><sup>2</sup> = 0%). The prehabilitation group had shorter length of hospital stay (weighted mean difference –0.2, 95% confidence interval –0.25 to –0.14, <i>P</i> < .0001, <i>I</i><sup>2</sup> = 43.3%). Prehabilitation and rehabilitation had similar odds of short-term complications (odds ratio 1.03, 95% confidence interval 0.56–1.89, <i>P</i> = .91, <i>I</i><sup>2</sup> = 33%), length of stay (weighted mean difference –0.16, 95% confidence interval –0.47 to 0.16, <i>P</i> = .33, <i>I</i><sup>2</sup> = 59%), and readmission (odds ratio 1.25, 95% confidence interval 0.28–5.56, <i>P</i> = .77, <i>I</i><sup>2</sup> = 52%). The only benefit of prehabilitation over rehabilitation was better 6-minute walking distance test results at time of surgery (weighted mean difference: –9.4 m; 95% confidence interval –18.04 to 0.79, <i>P</i> = .03, <i>I</i><sup>2</sup> = 42%). <h3>Conclusion</h3> Prehabilitation provided decreased postoperative length of hospital stay and improved preoperative functional outcomes, but not reduced odds of complications and/or readmissions. Prehabilitation and rehabilitation had similar clinical outcomes.