Comparative Efficacy of Different Prehabilitation Strategies in Colorectal Surgery Patients: A Network Meta-Analysis

To evaluate the effect of various prehabilitation strategies on postoperative functional capacity, complication rates, length of hospital stay, and readmission rates in colorectal surgery patients through a network meta-analysis.

A systematic search was performed across PubMed, Embase, Cochrane Library, Web of Science, and Scopus from inception to April 2025.

Randomized controlled trials comparing different prehabilitation strategies (multimodal prehabilitation, exercise-only, nutrition-only, and postoperative rehabilitation) with standard care or against each other were included.

Two investigators independently screened titles/abstracts and assessed full texts for eligibility, with discrepancies resolved through consensus or consultation with a third reviewer. The extracted data included the first author's name, publication year, country, design, sample size, participants' age, sex, pathology, surgical procedure, intervention type, and reported outcomes.

Fifteen studies involving 1290 participants were included. Compared with standard care, exercise intervention (mean difference, 62.85m; 95% CI, 9.44-116.12m) and multimodal prehabilitation (mean difference, 29.36m; 95% CI, 1.98-67.01m) significantly improved 6-minute walk test performance. Multimodal prehabilitation demonstrated superior efficacy in reducing postoperative complications (odds ratio, 0.65; 95% CI, 0.40-0.96), whereas other intervention methods showed no significant differences compared with standard care. The results of the network meta-analysis indicated that the best probability of improving the 6-minute walk test results was exercise intervention > multimodal prerehabilitation > nutritional intervention > postoperative rehabilitation > standard care. Heterogeneity across studies was low (I²<30%), with minimal risk of publication bias.

Multimodal prehabilitation emerges as the optimal preoperative strategy for colorectal surgery patients, significantly reducing complication risks and enhancing functional capacity. Exercise-only interventions also demonstrate clinically meaningful benefits in functional improvement. Tailored prehabilitation protocols should be implemented based on patient-specific needs and resource availability.