Defining standards and core outcomes for clinical trials in prehabilitation for colorectal surgery (DiSCO): modified Delphi methodology to achieve patient and healthcare professional consensus

Elective colorectal surgery constitutes some of the most commonly performed operations worldwide. Despite national databases reporting a low 90-day mortality rate (3–6%), postoperative morbidity is common and can delay in-hospital recovery, resulting in readmissions, reduced quality of life, and even reduce cancer-specific survival.

Prehabilitation is the process of physical, nutritional and psychological optimization prior to surgery and can augment the successes reported by Enhanced Recovery After Surgery (ERAS) programmes. Demonstrated as safe and feasible in colorectal patients, early trial data suggest that prehabilitation can reduce postoperative complications by 51%, as well as improving exercise capacity and decreasing length of hospital stay.

To strengthen the evidence and expedite prehabilitation implementation, systematic reviews have combined the small number of trials, reporting that the heterogeneity of data limits comparison. Limitations highlighted include: differing inclusion criteria focusing on patients with a malignant diagnosis and excluding those with benign pathology; differing methodology; variation in prehabilitation definition and disparity with the programme elements; and lastly, substantial variation in reported outcome measures. These reviews conclude that core standards and core outcome measures for prehabilitation are required. Core standards are a minimum set of agreed items that should be included in research methodology. Core outcomes are the minimum set of outcomes that should be reported in trials. Both core standards and core outcomes use relevant stakeholders, including patients, to achieve consensus and their subsequent adoption should improve the quality and comparison of future prehabilitation research.

The aim of the DiSCO (Defining Standards in Colorectal Optimisation) study was to achieve international consensus from patients and healthcare professionals on core standards and core outcomes for clinical trials of prehabilitation in elective colorectal surgery.