Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis
Abstract
Background & aims Although there have been meta-analyses of the effects of exercise-only prehabilitation on patients undergoing colorectal surgery, little is known about the effects of nutrition-only (oral nutritional supplements with and without counseling) and multimodal (oral nutritional supplements with and without counseling and with exercise) prehabilitation on clinical outcomes and patient function after surgery. We performed a systemic review and meta-analysis to determine the individual and combined effects of nutrition-only and multimodal prehabilitation compared with no prehabilitation (control) on outcomes of patients undergoing colorectal resection.Methods We searched Medline, EMBASE, CINAHL, CENTRAL, and ProQuest for cohort and randomized controlled studies of adults awaiting colorectal surgery who received at least 7 days of nutrition prehabilitation with or without exercise. We performed a random-effects meta-analysis to estimate the pooled risk ratio for categorical data and the weighted mean difference for continuous variables. The primary outcome was length of hospital stay; the secondary outcome was recovery of functional capacity based on results of a 6-minute walk test.Results We identified 9 studies (5 randomized controlled studies and 4 cohort studies) composed of 914 patients undergoing colorectal surgery (438 received prehabilitation and 476 served as controls). Receipt of any prehabilitation significantly decreased days spent in the hospital compared with controls (weighted mean difference of length of hospital stay = -2.2 days; 95% confidence interval = -3.5 to -0.9). Only 3 studies reported on functional outcomes but could not be pooled owing to methodologic heterogeneity. In the individual studies, multimodal prehabilitation significantly improved results of the 6-minute walk test at 4 and 8 weeks after surgery compared with standard Enhanced Recovery Pathway care and at 8 weeks compared with standard Enhanced Recovery Pathway care with added rehabilitation. The 4 observational studies had a high risk of bias.Conclusions In a systematic review and meta-analysis, we found that nutritional prehabilitation alone or combined with an exercise program significantly decreased length of hospital stay by 2 days in patients undergoing colorectal surgery. There is some evidence that multimodal prehabilitation accelerated the return to presurgical functional capacity.
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Reviews typically estimate one effect for either a single prehabilitation component or pool heterogeneous interventions together.
“Reviews typically estimate one effect for either a single prehabilitation component (eg, exercise only) or pool heterogeneous interventions together.1 14 17 18”
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Self-citation
- Authors
- Gillis, C., Buhler, K., Bresee, L., Carli, F., Gramlich, L., Culos-Reed, N., Sajobi, T. T., & Fenton, T. R.
- Affiliations
- University of Calgary (CA)
- Canada's Drug Agency (CA)
- McGill University Health Centre (CA)
- University of Alberta (CA)
- Alberta Health Services (CA)
- Corresponding author
- Gillis, Chelsia
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 155
- Issue
- 2
- Pages
- 391-410.e4
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2799559929
- Cited by
- 541
- References
- 57
- Citations by year
- 2026: 50 · 2025: 53 · 2024: 71 · 2023: 68 · 2022: 109 · 2021: 90 · 2020: 59 · 2019: 36 · 2018: 4
- FWCI
- 10.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- nutritional prehabilitation, exercise prehabilitation, colorectal surgery, oral nutritional supplements, multimodal prehabilitation, length of hospital stay, functional recovery, 6-minute walk test, enhanced recovery after surgery, postoperative rehabilitation
- MeSH terms
- Combined Modality Therapy, Counseling, Diet Therapy, Exercise Therapy, Humans, Length of Stay, Postoperative Complications, Preoperative Care, Digestive System Surgical Procedures, Treatment Outcome, Recovery of Function
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