Effectiveness of prehabilitation for patients with colorectal surgery: a systematic review and network meta-analysis

For colorectal surgery patients, prehabilitation can address common challenges in recovery, including muscle wasting, malnutrition, and emotional stress. This study aim to determine the impact of prehabilitation for patients with after colorectal surgery. We searched PubMed, Embase and Cochrane Library from inception up to April 2024. Two authors assessed the risk of bias by the Cochrane Risk of Bias tool-version 2. We computed mean difference (MD) on the basis of change values, with 95% credible interval (CI), for continuous outcomes (length of hospital stays (LOS and 6-min walk test (6MWT)), and risk ratios (RR) for categorical outcomes (number of patients with a complication). We conducted random effects meta-analysis within a Bayesian framework in R (RStudio, Boston, MA) and assessed the certainty of evidence using the grading of recommendations assessment, development and evaluation. Thirteen randomized controlled trials (RCTs) published were identified. Low-certainty evidence demonstrated that prehabilitation of exercise (3 studies; 185 patients; MD = 0.84, 95% CI -0.57 to 2.24), nutrition (3 studies; 279 patients; MD = -0.19, 95% CI -1.77 to 1.38), and exercise + nutrition (1 study; 44 patients; MD = -1.0, 95% CI -3.07 to 1.07), which may not differently when compared to standard care for LOS. Moderate-certainty evidence demonstrated that prehabilitation of exercise + nutrition + psychosocial (3 studies; 487 patients; MD = 51.57, 95% CI 14.39 to 88.76) probably increase patients' 6WMT. Low or very low certainty evidence demonstrated that prehabilitation of exercise (2 studies; 164 patients; RR = 0.86, 95% CI 0.47 to 1.59), nutrition (3 studies; 279 patients; RR = 1.05, 95% CI 0.79 to 1.41), exercise + nutrition (1 study; 44 patients; RR = 0.38, 95% CI 0.13 to 1.13), and exercise + nutrition + psychosocial (4 studies; 408 patients; RR = 0.77, 95% CI 0.6 to 1.0), which may not differently when compared to standard care for reduce patients' with a complication. The moderate-certainty evidence supporting an increase in 6MWT with the exercise + nutrition + psychosocial intervention highlights a potential benefit of this comprehensive approach; however, most comparisons are informed by limited data, yielding low to very low certainty evidence.