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Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews
Open accessAbstract
BACKGROUND The certainty that prehabilitation improves postoperative outcomes is not clear. The objective of this umbrella review (i.e. systematic review of systematic reviews) was to synthesise and evaluate evidence for prehabilitation in improving health, experience, or cost outcomes. METHODS We performed an umbrella review of prehabilitation systematic reviews. MEDLINE, Embase, Cochrane, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Joanna Briggs Institute's database, and Web of Science were searched (inception to October 20, 2020). We included all systematic reviews of elective, adult patients undergoing surgery and exposed to a prehabilitation intervention, where health, experience, or cost outcomes were reported. Evidence certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation. Primary syntheses of any prehabilitation were stratified by surgery type. RESULTS From 1412 titles, 55 systematic reviews were included. For patients with cancer undergoing surgery who participate in any prehabilitation, moderate certainty evidence supports improvements in functional recovery. Low to very low certainty evidence supports reductions in complications (mixed, cardiovascular, and cancer surgery), non-home discharge (orthopaedic surgery), and length of stay (mixed, cardiovascular, and cancer surgery). There was low to very low certainty evidence that exercise prehabilitation reduces the risk of complications, non-home discharge, and length of stay. There was low to very low certainty evidence that nutritional prehabilitation reduces risk of complications, mortality, and length of stay. CONCLUSIONS Low certainty evidence suggests that prehabilitation may improve postoperative outcomes. Future low risk of bias, randomised trials, synthesised using recommended standards, are required to inform practice. Optimal patient selection, intervention design, and intervention duration must also be determined.
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In the citing paper
“most available systematic reviews are rated as low quality1 16 and have not included patient and public perspectives.1”
In the citing paper
“Reviews typically estimate one effect for either a single prehabilitation component (eg, exercise only) or pool heterogeneous interventions together.1 14 17 18”
In the citing paper
“However, the overall certainty of benefit is low for several reasons.1”
In the citing paper
“Many reviews,11 12 13 14 including an umbrella review that synthesised 55 unique systematic reviews,1 suggest that prehabilitation may have protective effects in reducing complications, length of stay, and improving functional recovery.”
In the citing paper
“While this uncertainty is multifactorial, leading contributors are a lack of rigour in conduct of existing reviews, use of quantitative methods that do not align with the multicomponent nature of prehabilitation interventions, and risk of bias at the trial level.1”
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Metadata
- Authors
- McIsaac, D. I., Gill, M., Boland, L., Hutton, B., Branje, K., Shaw, J., Grudzinski, A. L., Barone, N., Gillis, C., Akhtar, S., Atkins, M., Aucoin, S., Auer, R., Basualdo-Hammond, C., Beaule, P., Brindle, M., Bittner, H., Bryson, G., Carli, F., Eskander, A., Fata, P., Fergusson, D., Fiore, J., Forster, A., Gillam, M., Gramlich, L., Holroyd-Leduc, J., Jackson, T., Jacobsohn, E., Khadaroo, R., Lalu, M., Love, C., Martel, G., McCartney, C., McKeen, D., Meliambro, A., Moloo, H., Moore, R., Muscedere, J., Nantel, J., Poitras, S., Scheede-Bergdahl, C., Taljaard, M., Wallace, T., & Wijeysundera, D.
- Affiliations
- University of Ottawa (CA)
- University of Calgary (CA)
- Ottawa Hospital Research Institute (CA)
- McGill University (CA)
- Yale University (US)
- Alberta Health Services (CA)
- Ottawa Hospital (CA)
- Sunnybrook Hospital (CA)
- University of Alberta (CA)
- University Health Network (CA)
- University of Manitoba (CA)
- Memorial University of Newfoundland (CA)
- Carleton University (CA)
- Kingston General Hospital (CA)
- University of British Columbia (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- McIsaac, Daniel I.
- Akhtar, Shamsuddin
- Atkins, Marlis
- Aucoin, Sylvie
- Auer, Rebecca
- Brindle, Mary
- Bittner, Honorata
- Bryson, Gregory
- Carli, Franco
- Eskander, Antoine
- Fata, Paola
- Fergusson, Dean
- Fiore, Julio
- Forster, Alan
- Gillam, Melani
- Gramlich, Leah
- Holroyd-Leduc, Jayna
- Jackson, Timothy
- Jacobsohn, Eric
- Khadaroo, Rachel
- Lalu, Manoj
- Love, Cameron
- Martel, Guillaume
- McCartney, Colin
- McKeen, Dolores
- Meliambro, Amanda
- Moloo, Husein
- Moore, Ronald
- Muscedere, John
- Nantel, Julie
- Taljaard, Monica
- Wallace, Tom
- Wijeysundera, Duminda
- ORCID
- McIsaac, Daniel I.
- Boland, Laura
- Hutton, Brian
- Branje, Karina
- Shaw, Julia
- Grudzinski, Alexa L.
- Barone, Natasha
- Gillis, Chelsia
- Akhtar, Shamsuddin
- Aucoin, Sylvie
- Auer, Rebecca
- Brindle, Mary
- Bryson, Gregory
- Carli, Franco
- Eskander, Antoine
- Fata, Paola
- Fergusson, Dean
- Fiore, Julio
- Forster, Alan
- Gillam, Melani
- Gramlich, Leah
- Holroyd-Leduc, Jayna
- Jackson, Timothy
- Jacobsohn, Eric
- Khadaroo, Rachel
- Lalu, Manoj
- Martel, Guillaume
- McCartney, Colin
- McKeen, Dolores
- Moloo, Husein
- Moore, Ronald
- Muscedere, John
- Nantel, Julie
- Taljaard, Monica
- Wallace, Tom
- Wijeysundera, Duminda
- Venue
- British Journal of Anaesthesia
- Publisher
- Elsevier BV
- Published
- 2022-02
- Volume
- 128
- Issue
- 2
- Pages
- 244-257
- ISSN
- 0007-0912 (ISSN-L)
- OpenAlex
- W4200413066
- Semantic Scholar
- ea56e19fb012b851f938df9f748371f43e1fef37
- Cited by
- 312
- References
- 98
- Citations by year
- 2026: 69 · 2025: 82 · 2024: 78 · 2023: 44 · 2022: 39
- FWCI
- 9.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- British Journal of Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ottawa Hospital Anesthesia Alternate Funds Association
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- prehabilitation, elective surgery, postoperative outcomes, cancer surgery, exercise prehabilitation, nutritional prehabilitation, postoperative complications, length of hospital stay, functional recovery, non-home discharge, cardiovascular surgery, orthopedic surgery, patient selection
- MeSH terms
- Systematic Reviews as Topic, Preoperative Exercise, Adult, Humans, Length of Stay, Postoperative Complications, Randomized Controlled Trials as Topic, Elective Surgical Procedures, Patient Selection, Nutrition Therapy
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