The impact of prehabilitation on outcomes in frail and high-risk patients undergoing major abdominal surgery: A systematic review and meta-analysis

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 43; no. 3; pp. 629 - 648
• Main Authors: Skořepa, Pavel, Ford, Katherine L., Alsuwaylihi, Abdulaziz, O'Connor, Dominic, Prado, Carla M., Gomez, Dhanny, Lobo, Dileep N.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2024
• Subjects: Abdomen - surgery; Aged; Complications; Exercise; Frail Elderly; Frailty; Humans; Older adult; Outcomes; Postoperative Complications - prevention & control; Prehabilitation; Preoperative Exercise; Preoperative preparation; RR; RCT; Older adult; Outcomes; ASA; QoL; Preoperative preparation; Frailty; MOOSE; WHO; CINAHL; PRISMA-S; OR; RevMan; Complications; CI; CCI; HADS; PRISMA; 6MWT; WMD; LOS; Prehabilitation; ESPEN; ERAS
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2024.01.020

Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes. The aim of this systematic review and meta-analysis was to determine the impact of prehabilitation on postoperative outcomes in frail and high-risk patients undergoing major abdominal surgery. Embase, Medline, CINAHAL and Cochrane databases were searched from January 2010 to January 2023 for randomised clinical trials (RCTs) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes. Meta-analysis was limited to length of stay (primary end point), severe postoperative complications (Clavien-Dindo Classification ≥ Grade 3) and the 6-minute walk test (6MWT). The analysis was performed using RevMan v5.4 software. Sixteen studies (6 RCTs, 10 observational) reporting on 3339 patients (1468 prehabilitation group, 1871 control group) were included. The median (interquartile range) age was 74.0 (71.0–78.4) years. Multimodal prehabilitation was applied in fifteen studies and unimodal in one. Meta-analysis of nine studies showed a reduction in hospital length of stay (weighted mean difference −1.07 days, 95 % CI −1.60 to −0.53 days, P < 0.0001, I2 = 19 %). Ten studies addressed severe complications and a meta-analysis suggested a decline in occurrence by up to 44 % (odds ratio 0.56, 95 % CI 0.37 to 0.82, P < 0.004, I2 = 51 %). Four studies provided data on preoperative 6MWT. The pooled weighted mean difference was 40.1 m (95 % CI 32.7 to 47.6 m, P < 0.00001, I2 = 24 %), favouring prehabilitation. Given the significant impact on shortening length of stay and reducing severe complications, prehabilitation should be encouraged in frail, older and high-risk adult patients undergoing major abdominal surgery.