Impact of preoperative uni- or multimodal prehabilitation on postoperative morbidity: meta-analysis

Abstract

Background Postoperative complications occur in up to 43% of patients after surgery, resulting in increased morbidity and economic burden. Prehabilitation has the potential to increase patients’ preoperative health status and thereby improve postoperative outcomes. However, reported results of prehabilitation are contradictory. The objective of this systematic review is to evaluate the effects of prehabilitation on postoperative outcomes (postoperative complications, hospital length of stay, pain at postoperative day 1) in patients undergoing elective surgery. Methods The authors performed a systematic review and meta-analysis of RCTs published between January 2006 and June 2023 comparing prehabilitation programmes lasting ≥14 days to ‘standard of care’ (SOC) and reporting postoperative complications according to the Clavien–Dindo classification. Database searches were conducted in PubMed, CINAHL, EMBASE, PsycINFO. The primary outcome examined was the effect of uni- or multimodal prehabilitation on 30-day complications. Secondary outcomes were length of ICU and hospital stay (LOS) and reported pain scores. Results Twenty-five studies (including 2090 patients randomized in a 1:1 ratio) met the inclusion criteria. Average methodological study quality was moderate. There was no difference between prehabilitation and SOC groups in regard to occurrence of postoperative complications (OR = 1.02, 95% c.i. 0.93 to 1.13; P = 0.10; I2 = 34%), total hospital LOS (−0.13 days; 95% c.i. −0.56 to 0.28; P = 0.53; I2 = 21%) or reported postoperative pain. The ICU LOS was significantly shorter in the prehabilitation group (−0.57 days; 95% c.i. −1.10 to −0.04; P = 0.03; I2 = 46%). Separate comparison of uni- and multimodal prehabilitation showed no difference for either intervention. Conclusion Prehabilitation reduces ICU LOS compared with SOC in elective surgery patients but has no effect on overall complication rates or total LOS, regardless of modality. Prehabilitation programs need standardization and specific targeting of those patients most likely to benefit.

The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies

“…Despite previous studies in non-cardiac surgery, although in the presence of a heterogeneous offering of treatment/exercises and delivery methods, having demonstrated some benefits of a pre-admission period of rehabilitation-prehabilitation-in terms of reducing the length of stay in the ICU [36] and postoperative complications [37,38], there is no univocal evidence regarding its efficacy. Prior experiences with cardiac surgery patients showed that a prehabilitation program was also feasible for patients scheduled for CABG surgery [39] and was associated with reduced ICU and hospital lengths of stays, faster postoperative recovery and improved postoperative quality of life [40,41].…”