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

OBJECTIVES

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.

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

STUDY SELECTION: 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.

DATA EXTRACTION: 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.

DATA SYNTHESIS: 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.

CONCLUSIONS

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.