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Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis.
Gastroenterology 2018; 155(2):391-410.e4G

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.

Authors+Show Affiliations

Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: chelsia.gillis@ucalgary.ca.Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.Department of Anesthesia, McGill University Health Center, Montreal, Quebec, Canada.Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.Faculty of Kinesiology and Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada.Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.Department of Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Nutrition Services, Alberta Health Services, Calgary, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

29750973

Citation

Gillis, Chelsia, et al. "Effects of Nutritional Prehabilitation, With and Without Exercise, On Outcomes of Patients Who Undergo Colorectal Surgery: a Systematic Review and Meta-analysis." Gastroenterology, vol. 155, no. 2, 2018, pp. 391-410.e4.
Gillis C, Buhler K, Bresee L, et al. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology. 2018;155(2):391-410.e4.
Gillis, C., Buhler, K., Bresee, L., Carli, F., Gramlich, L., Culos-Reed, N., ... Fenton, T. R. (2018). Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology, 155(2), pp. 391-410.e4. doi:10.1053/j.gastro.2018.05.012.
Gillis C, et al. Effects of Nutritional Prehabilitation, With and Without Exercise, On Outcomes of Patients Who Undergo Colorectal Surgery: a Systematic Review and Meta-analysis. Gastroenterology. 2018;155(2):391-410.e4. PubMed PMID: 29750973.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. AU - Gillis,Chelsia, AU - Buhler,Katherine, AU - Bresee,Lauren, AU - Carli,Francesco, AU - Gramlich,Leah, AU - Culos-Reed,Nicole, AU - Sajobi,Tolulope T, AU - Fenton,Tanis R, Y1 - 2018/05/08/ PY - 2017/09/27/received PY - 2018/04/10/revised PY - 2018/05/03/accepted PY - 2018/5/12/pubmed PY - 2018/8/14/medline PY - 2018/5/12/entrez KW - Enhanced Recovery After Surgery KW - Enhanced Recovery Pathway KW - Prehab KW - Preoperative Nutrition KW - Surgery Preparation SP - 391 EP - 410.e4 JF - Gastroenterology JO - Gastroenterology VL - 155 IS - 2 N2 - 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. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/29750973/Effects_of_Nutritional_Prehabilitation_With_and_Without_Exercise_on_Outcomes_of_Patients_Who_Undergo_Colorectal_Surgery:_A_Systematic_Review_and_Meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(18)34530-X DB - PRIME DP - Unbound Medicine ER -