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Cited by 126Enhanced Recovery After SurgeryCardiac, Anesthesia and Surgical OutcomesHemodynamic Monitoring and Therapy

Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: a systematic review and meta-analysis

Kamarajah, Sivesh K., Bundred, James, Weblin, Jonathan, Tan, Benjamin H.L.·2020·Surgery
DOI 10.1016/j.surg.2019.07.032
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Abstract

BACKGROUND There has been increasing interest in the prehabilitation of patients undergoing major abdominal surgery to improve perioperative outcomes. This systematic review and meta-analysis aims to evaluate and compare the current literature on prehabilitation in major abdominal surgery and cardiothoracic surgery METHODS: A systematic literature search was conducted for studies reporting prehabilitation in patients undergoing major abdominal and cardiothoracic surgery. Meta-analysis of postoperative outcomes (overall and major complications, pulmonary and cardiac complications, postoperative pneumonia, and length of hospital stay) was performed using random effects models. RESULTS Five thousand nine hundred and twenty-one patients underwent prehabilitation in 61 studies, of which 35 studies (n = 3,402) were in major abdominal surgery and 26 studies were in cardiothoracic surgery (n = 2,519). Only 45 studies compared the impact of prehabilitation versus no prehabilitation on postoperative outcomes (abdominal, n = 26; cardiothoracic, n = 19). Quality of evidence for prehabilitation in major abdominal and cardiothoracic surgery appear equivalent. Patients receiving prehabilitation for major abdominal surgery have significantly lower rates of overall (n = 10, odds ratio: 0.61, confidence interval 95%: 0.43-0.86, P = .005), pulmonary (n = 15, odds ratio: 0.41, confidence interval 95%: 0.25-0.67, P < .001), and cardiac complications (n = 4, odds ratio: 0.46, confidence interval 95%: 0.22-0.96, P = .044). Sensitivity analysis including randomized controlled trials only did not alter the findings of this study. CONCLUSION Prehabilitation has the potential to improve surgical outcomes in patients undergoing major abdominal and cardiothoracic surgery. However, current evidence from randomized studies remains weak owing to variation in prehabilitation regimes, limiting the assessment of current postoperative outcomes.

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Authors
Kamarajah, S. K., Bundred, J., Weblin, J., & Tan, B. H. L.
Affiliations
  • Freeman Hospital (GB)
  • University of Birmingham (GB)
  • Queen Elizabeth Hospital Birmingham (GB)
  • University Hospitals Birmingham NHS Foundation Trust (GB)
Corresponding author
Tan, Benjamin H.L.
ORCID
Venue
Surgery
Publisher
Elsevier BV
Published
2020-03
Volume
167
Issue
3
Pages
540-549
ISSN
0039-6060 (ISSN-L)
DOI
10.1016/j.surg.2019.07.032
OpenAlex
W2973737373
Semantic Scholar
2e4638b200d86cedc637582b779c1290c14e081b
Cited by
126
References
95
Citations by year
2026: 8 · 2025: 16 · 2024: 17 · 2023: 18 · 2022: 23 · 2021: 27 · 2020: 15 · 2014: 1
FWCI
3.35
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
National Institute for Health and Care Research (ACF-2020-09-001)
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, major abdominal surgery, cardiothoracic surgery, postoperative complications, pulmonary complications, cardiac complications, postoperative pneumonia, length of hospital stay, perioperative outcomes
MeSH terms
Humans, Length of Stay, Postoperative Complications, Preoperative Care, Surgical Procedures, Operative, Time Factors, Randomized Controlled Trials as Topic, Treatment Outcome, Hospital Mortality, Abdominal Cavity, Thoracic Cavity

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