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. 2021 Mar 19:8:628848.
doi: 10.3389/fsurg.2021.628848. eCollection 2021.

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

Jamie L Waterland  1   2   3 , Orla McCourt  4 , Lara Edbrooke  2   3 , Catherine L Granger  2   5 , Hilmy Ismail  1   6 , Bernhard Riedel  1   6 , Linda Denehy  2   3
Affiliations

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

Jamie L Waterland et al. Front Surg. .

Abstract

Objectives: This systematic review set out to identify, evaluate and synthesise the evidence examining the effect of prehabilitation including exercise on postoperative outcomes following abdominal cancer surgery. Methods: Five electronic databases (MEDLINE 1946-2020, EMBASE 1947-2020, CINAHL 1937-2020, PEDro 1999-2020, and Cochrane Central Registry of Controlled Trials 1991-2020) were systematically searched (until August 2020) for randomised controlled trials (RCTs) that investigated the effects of prehabilitation interventions in patients undergoing abdominal cancer surgery. This review included any form of prehabilitation either unimodal or multimodal that included whole body and/or respiratory exercises as a stand-alone intervention or in addition to other prehabilitation interventions (such as nutrition and psychology) compared to standard care. Results: Twenty-two studies were included in the systematic review and 21 studies in the meta-analysis. There was moderate quality of evidence that multimodal prehabilitation improves pre-operative functional capacity as measured by 6 min walk distance (Mean difference [MD] 33.09 metres, 95% CI 17.69-48.50; p = <0.01) but improvement in cardiorespiratory fitness such as preoperative oxygen consumption at peak exercise (VO2 peak; MD 1.74 mL/kg/min, 95% CI -0.03-3.50; p = 0.05) and anaerobic threshold (AT; MD 1.21 mL/kg/min, 95% CI -0.34-2.76; p = 0.13) were not significant. A reduction in hospital length of stay (MD 3.68 days, 95% CI 0.92-6.44; p = 0.009) was observed but no effect was observed for postoperative complications (Odds Ratio [OR] 0.81, 95% CI 0.55-1.18; p = 0.27), pulmonary complications (OR 0.53, 95% CI 0.28-1.01; p = 0.05), hospital re-admission (OR 1.07, 95% CI 0.61-1.90; p = 0.81) or postoperative mortality (OR 0.95, 95% CI 0.43-2.09, p = 0.90). Conclusion: Multimodal prehabilitation improves preoperative functional capacity with reduction in hospital length of stay. This supports the need for ongoing research on innovative cost-effective prehabilitation approaches, research within large multicentre studies to verify this effect and to explore implementation strategies within clinical practise.

Keywords: cancer; meta-analysis; prehabilitation; surgery; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart of included and excluded studies within this systematic review and meta-analysis (25).
Figure 2
Figure 2
Meta-analysis of change in oxygen consumption (VO2) at peak (ml per kg per min) after prehabilitation.
Figure 3
Figure 3
Meta-analysis of change in anaerobic threshold (AT) (ml per kg per min) after prehabilitation.
Figure 4
Figure 4
Meta-analysis of pre-surgical change in 6MWD (m) after prehabilitation.
Figure 5
Figure 5
Meta-analysis of postoperative complications based on intervention group.
Figure 6
Figure 6
Meta-analysis of postoperative pulmonary complications based on intervention group.
Figure 7
Figure 7
Meta-analysis of hospital length of stay (days).
Figure 8
Figure 8
Meta-analysis of hospital re-admission after surgery.
Figure 9
Figure 9
Meta-analysis of postoperative mortality.
Figure 10
Figure 10
The Cochrane risk of bias assessment of randomised controlled trials. Green (+) = low risk; Yellow (?) = unclear risk; Red (-) = high risk.
See this image and copyright information in PMC

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