The Role and Effect of Multimodal Prehabilitation Before Major Abdominal Surgery: A Systemic Review and Meta-Analysis.

Autor: Jain SR; Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore., Kandarpa VL; Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore., Yaow CYL; Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore., Tan WJ; Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore., Ho LML; Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore., Sivarajah SS; Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore., Ng JL; Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore., Chong CXZ; Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore., Aw DKL; Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore., Foo FJ; Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore., Koh FHX; Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore. frederickkohhx@gmail.com.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2023 Jan; Vol. 47 (1), pp. 86-102. Date of Electronic Publication: 2022 Oct 02.
DOI: 10.1007/s00268-022-06761-0
Abstrakt: Background: For patients undergoing abdominal surgery, multimodal prehabilitation, including nutrition and exercise interventions, aims to optimize their preoperative physical and physiological capacity. This meta-analysis aims to explore the impact of multimodal prehabilitation on surgical and functional outcomes of abdominal surgery.
Methods: Medline, Embase and CENTRAL were searched for articles about multimodal prehabilitation in major abdominal surgery. Primary outcomes were postoperative complications with a Clavien-Dindo score ≥3, and functional outcomes, measured by the 6-Minute Walking Test (6MWT). Secondary outcome measures included the quality-of-life measures. Pooled risk ratio (RR) and 95% confidence interval (CI) were estimated, with DerSimonian and Laird random effects used to account for heterogeneity.
Results: Twenty-five studies were included, analysing 4,210 patients across 13 trials and 12 observational studies. Patients undergoing prehabilitation had significantly fewer overall complications (RR = 0.879, 95% CI 0.781-0.989, p = 0.034). There were no significant differences in the rates of wound infection, anastomotic leak and duration of hospitalization. The 6MWT improved preoperatively in patients undergoing prehabilitation (SMD = 33.174, 95% CI 12.674-53.673, p = 0.005), but there were no significant differences in the 6MWT at 4 weeks (SMD = 30.342, 95% CI - 2.707-63.391, p = 0.066) and 8 weeks (SMD = 24.563, 95% CI - 6.77-55.900, p = 0.104) postoperatively.
Conclusions: As preoperative patient optimization shifts towards an interdisciplinary approach, evidence from this meta-analysis shows that multimodal prehabilitation improves the preoperative functional capacity and reduces postoperative complication rates, suggesting its potential in effectively optimizing the abdominal surgery patient. However, there is a large degree of heterogenicity between the prehabilitation interventions between included articles; hence results should be interpreted with caution.
(© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)
Databáze: MEDLINE
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