Impact of Multidisciplinary Prehabilitation Interventions on Postoperative Hospital Length of Stay and Functional Capacity in Patients Undergoing Resection of Colorectal Cancer: A Systematic Review and Meta-analysis.

Abstract

Background: Although surgery is commonly regarded as the primary curative treatment for colorectal cancer, it could potentially be associated with postoperative morbidity and mortality.

Objective: To determine the pooled effect of exercise and multidisciplinary prehabilitation interventions on postoperative hospital length of stay and functional capacity in patients undergoing resection of colorectal cancer.

Data sources: A systematic search was conducted in MEDLINE (via PubMed) and Web of Science databases from inception to November 2022.

Study selection: The original systematic search retrieved 2005 studies. After the removal of duplicates and screening by title and abstract, 77 eligible full-text documents were evaluated for final inclusion in the meta-analysis. A total of 12 randomized controlled trials, 5 nonrandomized controlled trials, and 3 uncontrolled before-and-after studies were selected.

Main outcome measures: Postoperative hospital length of stay (in days) and functional capacity (assessed with the peak of oxygen consumption [VO2 peak] and 6-minute walking test) were the outcome measures.

Results: The meta-analysis was conducted on 20 studies (3805 participants). Randomized controlled trials and nonrandomized controlled trials showed significant reductions in postoperative hospital length of stay (d = -0.10, nearly 2 days) and significant incremental improvements in VO2 peak (d = 0.27) and 6-minute walking test (d = 0.31). Regarding the before-and-after studies, the pooled effect of multidisciplinary prehabilitation interventions was positively significant for VO2 peak (d = 0.29) and 6-minute walking test (d = 0.29). There was no risk of publication bias (Egger test: p > 0.05), with a score of 0.71 (0-1) on average.

Limitations: There was a high between-studies heterogeneity, and several outcomes did not have the required number of studies for a desirable statistical power.

Conclusions: These findings suggest that multidisciplinary prehabilitation interventions might be effective at decreasing postoperative hospital length of stay (nearly 2 days) and improving functional capacity.

Registration: PROSPERO registration number CRD42022373982.