A multimodal prehabilitation class for Enhanced Recovery After Surgery: a pragmatic randomised type 1 hybrid...

Area of Science:

• Colorectal surgery outcomes
• Prehabilitation strategies
• Enhanced Recovery After Surgery (ERAS) pathways

Background:

• Prehabilitation optimizes postoperative recovery but real-world data is limited.
• A pragmatic trial investigated multimodal prehabilitation within an ERAS pathway for colorectal surgery.
• The hypothesis was that prehabilitation would reduce length of hospital stay (LOS).

Purpose of the Study:

• To evaluate the effectiveness of a multimodal prehabilitation program on intermediate and late recovery after colorectal surgery.
• To assess implementation outcomes of the prehabilitation program.
• To determine if prehabilitation influences length of hospital stay and functional recovery.

Main Methods:

• A randomized pragmatic trial included adult patients undergoing elective colorectal resection.
• The intervention group received enhanced prehabilitation (nutrition, exercise, breathing) alongside standard ERAS care.
• Effectiveness outcomes included LOS and 6-min walking distance (6MWD); implementation outcomes included adherence to step count and nutrient intake.

Main Results:

• The trial was terminated early, including 110 patients; 66% had cancer.
• No significant difference in LOS between prehabilitation and standard care groups.
• Prehabilitation significantly reduced preoperative protein inadequacy and improved 6-week 6MWD by 38m.

Conclusions:

• A pragmatic prehabilitation program did not impact LOS due to early termination.
• The program effectively reduced preoperative protein inadequacy.
• Early functional recovery, measured by 6MWD, was significantly improved by prehabilitation.