Title : Impact of multimodal prehabilitation on functional recovery, hospital stay and cost-effectiveness in colorectal surgery: A systematic review and meta-analysis of randomized controlled trials
Abstract:
Background: Multimodal prehabilitation aims to optimize patients’ physical and psychological readiness for surgery through interventions such as exercise, nutritional support, and psychological counseling. While Enhanced Recovery After Surgery (ERAS) protocols have improved postoperative outcomes in colorectal surgery, the addition of prehabilitation may further enhance functional recovery and reduce complications. This review evaluates the effect of multimodal prehabilitation on functional capacity, hospital stay, and cost-effectiveness in colorectal surgery patients within the context of ERAS-based care.
Methods: A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library, and Scopus over last 10 years for randomized controlled trials (RCTs) comparing multimodal prehabilitation with standard preoperative care in adults undergoing elective colorectal surgery. The primary outcome was postoperative 6-minute walk distance (6MWD), a measure of functional capacity. Secondary outcomes included length of hospital stay and cost-effectiveness. Meta-analysis was conducted using a random-effects model, and results were expressed as mean differences (MD) with 95% confidence intervals (CI). Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool.
Results: Seven RCTs involving 1339 patients were included. Multimodal prehabilitation significantly improved postoperative 6MWD compared to standard care (MD: +35.2 meters, 95% CI: +18.1 to +52.3, p < 0.001), indicating enhanced functional recovery. A modest but statistically significant reduction in hospital stay was observed (MD: –1.3 days, 95% CI: –2.4 to –0.2, p = 0.02). Three studies included cost-effectiveness analyses, all reporting favorable economic outcomes due to reduced postoperative complications and shorter hospital stays. Heterogeneity was moderate for 6MWD (I² = 48%) and high for hospital stay (I² = 71%).
Conclusion: Multimodal prehabilitation significantly improves early functional recovery and may reduce hospital stay and healthcare costs in patients undergoing colorectal surgery. When implemented alongside ERAS protocols, prehabilitation appears to offer additional synergistic benefits by enhancing physiological resilience and promoting faster recovery. These findings support integrating structured prehabilitation programs as an adjunct to ERAS pathways in elective colorectal surgical care.
Keywords: Multimodal prehabilitation, colorectal surgery, ERAS, 6-minute walk distance, functional recovery, hospital stay, cost-effectiveness, meta-analysis.
