Prehabilitation in hepato-pancreato-biliary surgery: A systematic review and meta-analysis. A necessary step forward evidence-based sample size calculation for future trials
| Autor: | Giuliana Amaddeo, Daniele Sommacale, Alexis Laurent, R. Brustia, Eric Levesque, Arié Attias, Nicolas Mongardon, C. Dagorno, V. Leroy, Rami Rhaiem, Olivier Langeron |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Evidence-based practice business.industry Prehabilitation Preoperative Exercise General Medicine Length of Stay Colorectal surgery law.invention Surgery Postoperative Complications Systematic review Randomized controlled trial Sample size determination law Sample Size Meta-analysis Preoperative Care Propensity score matching medicine Humans business Digestive System Surgical Procedures Randomized Controlled Trials as Topic |
| Zdroj: | Journal of Visceral Surgery. 159:362-372 |
| ISSN: | 1878-7886 |
| Popis: | Summary Introduction Prehabilitation is defined as preoperative conditioning of patients in order to improve post-operative outcomes. Some studies showed an increase in functional recovery following colorectal surgery, but its effect in hepato-pancreato-biliary (HPB) surgery is unclear. The aim of this study was to realize a systematic literature review and meta-analysis on the current available evidence on prehabilitation in HPB surgery. Materials and methods A systematic review and a metanalysis were carried out on prehabilitation (physical, nutritional and psychological interventions) in HPB surgery (2009-2019). Assessed outcomes were postoperative complications, length of stay (LOS), 30-day readmission, and mortality. Main results Four studies among the 191 screened were included in this systematic review (3 randomized controlled trials, 1 case-control propensity score study), involving 419 patients (prehabilitation group, n = 139; control group, n = 280). After pooling, no difference was observed on LOS ((−4.37 days [95% CI: −8.86; 0.13]) or postoperative complications (RR 0.83 [95%CI: 0.62; 1.10]), reported by all the included studies. Two trials reported on readmission rate, but given the high heterogeneity, a meta-analysis was not realized. No deaths were reported among the included studies. Conclusion No effect of prehabilitation programs in HPB surgery was observed on LOS or postoperative complications rate. Future trials with standardized outcomes of measure, and adequately powered samples calculations are thus required. PROSPERO registration CRD42020165218. |
| Databáze: | OpenAIRE |
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