Background
Preoperative physical fitness is predictive of postoperative outcome. Patients with
lesser aerobic capacity are at greater risk of postoperative complications, longer
hospital stays, and mortality. Prehabilitation may improve physical fitness, but it
is unknown whether enhanced fitness translates to an improvement in postoperative
outcome.
Methods
This systematic review and meta-analysis aimed to assess the ability of prehabilitation
to influence postoperative outcome after intra-abdominal operations. Randomized controlled
trials with at least 1 group undergoing a preoperative exercise intervention/prehabilitation
were included. The following databases were searched: AMED, CINAHL, EMBASE, PubMed/Medline,
and The Cochrane Library. Data extracted from 9 full-articles included author(s),
population demographics, type of operation, postoperative measures of outcome, and
type of treatment of the prehabilitation and control groups. Methodologic quality
was assessed using GRADEpro, and the Cochrane risk of bias tool was used to measure
study bias.
Results
Prehabilitation consisting of inspiratory muscle training, aerobic exercise, and/or
resistance training can decrease all types of postoperative complications after intra-abdominal
operations (odds ratio: 0.59, 95% confidence interval: 0.38–0.91, P = .03). It is unclear from our meta-analysis whether prehabilitation can decrease
postoperative length of stay, because the number of studies that examined length of
stay was small (n = 4). No postoperative mortality was reported in any study, and conclusions could
not be drawn on the ability of exercise to influence operative mortality. The methodologic quality
of studies was, however, “very low.”
Conclusion
Prehabilitation appears to be beneficial in decreasing the incidence of postoperative
complications; however, more high-quality studies are needed to validate its use in
the preoperative setting.
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Article info
Publication history
Published online: July 08, 2016
Accepted:
May 5,
2016
Footnotes
Supported by a studentship grant from Trinity College Dublin (J. Moran).
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
