Clinical Scorecard: Incorporating Multimodal Prehabilitation into Enhanced Recovery After Surgery Protocols for Older Adults: A Systematic Review and Meta-Analysis of Randomized Trials and Cohort Studies

At a Glance

Key Highlights

• Multimodal prehabilitation showed statistically significant improvement in 6-minute walk test distance (mean difference 18.38 m).
• No significant differences were found in length of hospital stay, postoperative complications, or quality of life compared to ERAS alone or ERAS with postoperative rehabilitation.
• Current evidence is limited and further research is needed to optimize and target prehabilitation interventions in this population.

Guideline-Based Recommendations

Diagnosis

• Identify elderly patients with colorectal cancer scheduled for elective surgery as candidates for ERAS protocols.

Management

• Consider integrating multimodal prehabilitation (exercise, nutrition, psychological, spiritual support) into ERAS pathways for elderly colorectal cancer patients.
• Continue standard ERAS care with or without postoperative rehabilitation as comparative approaches.

Monitoring & Follow-up

• Assess functional capacity pre- and postoperatively using measures such as the 6-minute walk test.
• Monitor postoperative complications using standardized classifications (e.g., Clavien-Dindo).
• Evaluate quality of life outcomes longitudinally.

Risks

• No increased risk of postoperative complications observed with multimodal prehabilitation compared to controls.
• Potential limited clinical benefit on length of stay and quality of life should be considered.

Patient & Prescribing Data

Older adults (65–82 years) undergoing elective colorectal cancer surgery

Multimodal prehabilitation may improve functional capacity preoperatively but does not significantly reduce hospital stay or postoperative complications; personalization and further research are needed.

Clinical Best Practices

• Implement multimodal prehabilitation as part of ERAS protocols to enhance functional capacity in elderly colorectal cancer patients.
• Use standardized outcome measures such as the 6-minute walk test to evaluate intervention effectiveness.
• Maintain vigilance for postoperative complications using validated classification systems.
• Tailor prehabilitation components to individual patient needs and capabilities.
• Encourage multidisciplinary collaboration including surgery, nutrition, physiotherapy, and psychological support.

References

• Colorectal Cancer. World Health Organization (2023)
• Holt PR, Kozuch P, Mewar S (2009) Colon cancer and the elderly: from screening to treatment
• Itatani Y, Kawada K, Sakai Y (2018) Treatment of elderly patients with colorectal cancer
• Gustafsson UO et al (2018) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations
• Doody P et al (2022) Frailty: pathophysiology, impact, management and prevention
• Durrand J, Singh SJ, Danjoux G (2019) Prehabilitation
• Shakya P, Poudel S (2022) Prehabilitation in patients before major surgery: a review article
• Clavien PA et al (2009) The Clavien-Dindo classification of surgical complications