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Cited by 37Enhanced Recovery After SurgeryCardiac, Anesthesia and Surgical OutcomesSurgical site infection prevention

The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: a systematic review and meta-analyses

Open access
Fong, Mackenzie, Kaner, Eileen, Rowland, Maisie, Graham, Henrietta E., McEvoy, Louise, Hallsworth, Kate, Cucato, Gabriel, Gibney, Carla +3 more·2023·PLoS ONE
DOI 10.1371/journal.pone.0286757PMC PMC10321619
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Abstract

BACKGROUND: Prehabilitation interventions are being delivered across surgical specialities to improve health risk behaviours leading to better surgical outcomes and potentially reduce length of hospital stay. Most previous research has focused on specific surgery specialities and has not considered the impact of interventions on health inequalities, nor whether prehabilitation improves health behaviour risk profiles beyond surgery. The aim of this review was to examine behavioural Prehabilitation interventions across surgeries to inform policy makers and commissioners of the best available evidence. METHODS AND FINDINGS: A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to determine the effect of behavioural prehabilitation interventions targeting at least one of: smoking behaviour, alcohol use, physical activity, dietary intake (including weight loss interventions) on pre- and post-surgery health behaviours, health outcomes, and health inequalities. The comparator was usual care or no treatment. MEDLINE, PubMed, PsychINFO, CINAHL, Web of Science, Google Scholar, Clinical trials and Embase databases were searched from inception to May 2021, and the MEDLINE search was updated twice, most recently in March 2023. Two reviewers independently identified eligible studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tool. Outcomes were length of stay, six-minute walk test, behaviours (smoking, diet, physical activity, weight change, and alcohol), and quality of life. Sixty-seven trials were included; 49 interventions targeted a single behaviour and 18 targeted multiple behaviours. No trials examined effects by equality measures. Length of stay in the intervention group was 1.5 days shorter than the comparator (n = 9 trials, 95% CI -2.6 to -0.4, p = 0.01, I2 83%), although in sensitivity analysis prehabilitation had the most impact in lung cancer patients (-3.5 days). Pre-surgery, there was a mean difference of 31.8 m in the six-minute walk test favouring the prehabilitation group (n = 19 trials, 95% CI 21.2 to 42.4m, I2 55%, P <0.001) and this was sustained to 4-weeks post-surgery (n = 9 trials, mean difference = 34.4m (95%CI 12.8 to 56.0, I2 72%, P = 0.002)). Smoking cessation was greater in the prehabilitation group before surgery (RR 2.9, 95% CI 1.7 to 4.8, I2 84%), and this was sustained at 12 months post-surgery (RR 1.74 (95% CI 1.20 to 2.55, I2 43%, Tau2 0.09, p = 0.004)There was no difference in pre-surgery quality of life (n = 12 trials) or BMI (n = 4 trials). CONCLUSIONS: Behavioural prehabilitation interventions reduced length of stay by 1.5 days, although in sensitivity analysis the difference was only found for Prehabilitation interventions for lung cancer. Prehabilitation can improve functional capacity and smoking outcomes just before surgery. That improvements in smoking outcomes were sustained at 12-months post-surgery suggests that the surgical encounter holds promise as a teachable moment for longer-term behavioural change. Given the paucity of data on the effects on other behavioural risk factors, more research grounded in behavioural science and with longer-term follow-up is needed to further investigate this potential.

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Authors
Fong, M., Kaner, E., Rowland, M., Graham, H. E., McEvoy, L., Hallsworth, K., Cucato, G., Gibney, C., Nedkova, M., Prentis, J., & Madigan, C. D.
Affiliations
  • Newcastle University (GB)
  • Loughborough University (GB)
  • Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
  • Northumbria University (GB)
Corresponding author
Fong, Mackenzie
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2023-07-05
Volume
18
Issue
7
Pages
e0286757
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0286757
PMC
PMC10321619
OpenAlex
W4383199194
Cited by
37
References
122
Citations by year
2026: 14 · 2025: 12 · 2024: 10 · 2023: 1
FWCI
2.39
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by)
Funders
National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NIHR200173)
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 › Surgical site infection prevention
Keywords
prehabilitation, health disparities, smoking cessation, alcohol consumption, physical activity, dietary intake, weight loss, length of hospital stay, 6-minute walk test, quality of life, lung cancer surgery, surgical outcomes, health risk behaviors
MeSH terms
Adult, Diet, Humans, Lung Neoplasms, Risk Factors, Exercise, Smoking Cessation

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