Prehabilitation and postoperative outcomes in colorectal surgery: an umbrella review

Colorectal surgery caries a risk of postoperative morbidity and mortality. Prehabilitation may improve recovery and reduce complications in this population. This umbrella review evaluates the effects of prehabilitation on postoperative outcomes. Google Scholar, PubMed, the Cochrane Library, and HINARI were searched for systematic reviews comparing the effect of prehabilitation with usual care on postoperative complications, length of hospital stays and functional capacity in adults undergoing colorectal surgery. The methodological quality was assessed by using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). Overlap of primary studies was evaluated using the Corrected Covered Area (CCA), while evidence certainty by Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Heterogeneity was measured using I-squared statistic, and publication bias was examined using funnel plot, Egger’s test and Trim and Fill method. This umbrella review included 19 systematic reviews with 27,065 participants, most of which were high quality (n = 13; 68.4%). Overall overlap was slight; however, moderate overlap was observed for postoperative complications, length of hospital stay (LOS), and functional capacity. Prehabilitation was associated with a 21% reduction in postoperative complications (risk ratio (RR) = 0.79, 95% CI: 0.69 to 0.89, I 2 = 66.5%) with consistent finding in sensitivity analysis excluding short-duration nutritional interventions. It was also associated with a reduction in LOS of approximately 0.5 days (mean difference (MD) = -0.54 days, 95% CI: -0.87 to -0.20; I 2 = 80.4%). Both with low certainty of evidence. Similarly, prehabilitation appeared to improve preoperative and postoperative functional capacity by approximately 25 m (MD = 24.78 m, 95% CI: 11.35 to 38.22, I 2 = 67.84%) and 35 m (MD = 34.52 m, 95% CI: 6.44 to 62.60, I 2 = 74.63%) respectively with low certainty evidence. Systematic reviews that did not present pooled results suggested that prehabilitation reduced postoperative complications (OR), had no significant effect on length of stay (SMD), and generally improved functional capacity (SMD or narrative synthesis). Prehabilitation in colorectal surgery may reduce postoperative complications, may shorten hospital stay, may improve preoperative and postoperative functional capacity, highlighting faster recovery and improve postoperative quality of life. Findings should be interpreted with caution for the moderate overlap of primary studies, low level certainty, and significant heterogeneity.