O083 The impact of prehabilitation on outcomes in frail, older adult patients undergoing major abdominal surgery: a systematic review and meta-analysis

Autor: P Skořepa, K L Ford, C M Prado, D Gomez, D N Lobo
Rok vydání: 2023
Předmět:
Zdroj: British Journal of Surgery. 110
ISSN: 1365-2168
0007-1323
DOI: 10.1093/bjs/znad101.083
Popis: Introduction Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes. The aim of this study was to determine the impact of prehabilitation on postoperative outcomes in frail, older adult patients undergoing abdominal surgery. Methods Embase, Medline, CINAHAL and Cochrane databases were searched from 2010 to 2022 for prospective randomised clinical trials (RCT) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes. The primary endpoint was the development of severe postoperative complications. Secondary endpoints, among others, included length of hospital stay. The analysis was performed using RevMan v5.4 software. Results Sixteen studies (6 RCT, 10 observational) reporting on 3339 patients (1406 prehabilitation group, 1933 control group) were included. The median (interquartile range) age was 74.0 (71.0–78.4) years. Ten studies reported on patients undergoing colorectal surgery. Of the remaining studies, two investigated prehabilitation in patients undergoing mixed gastrointestinal surgeries, two in gastric and oesophageal surgery, and two in hepatobiliary surgery. Prehabilitation was multimodal in the majority of studies and was unimodal in one study. Ten studies addressed severe complications and a meta-analysis revealed a decline in their occurrence by up to 44% (OR 0.56, 95% CI 0.37 to 0.82). Meta-analysis of nine studies showed a reduction in hospital stay (WMD -1.07, -1.60 to -0.53). Conclusion Given the significant impact on severe complications and tendency to shorten length of stay, prehabilitation should be encouraged in routine practice in frail, older adult patients undergoing major abdominal surgery.
Databáze: OpenAIRE
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