Prehabilitation for general surgery: a systematic review of randomized controlled trials.
general surgery
outcomes
prehabilitation
preoperative rehabilitation
recovery
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
revised:
23
07
2023
received:
03
06
2023
accepted:
27
08
2023
medline:
23
10
2023
pubmed:
7
9
2023
entrez:
7
9
2023
Statut:
ppublish
Résumé
Prehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline-level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery. This study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta-analysis was precluded due to heterogeneity across included studies. From 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%). Prehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system-level delivery across General Surgery within standardized protocols. However, given potential benefits and non-inferiority to standard care, they should be considered on a case-by-case basis.
Sections du résumé
BACKGROUND
Prehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline-level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery.
METHODS
This study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta-analysis was precluded due to heterogeneity across included studies.
RESULTS
From 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%).
CONCLUSIONS
Prehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system-level delivery across General Surgery within standardized protocols. However, given potential benefits and non-inferiority to standard care, they should be considered on a case-by-case basis.
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2411-2425Informations de copyright
© 2023 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
Références
Wynter-Blyth V, Moorthy K. Prehabilitation: preparing patients for surgery. BMJ. 2017; 358: j3702.
Borrell-Carrió F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann. Family Med. 2004; 2: 576-582.
Le Roy B, Selvy M, Slim K. The concept of prehabilitation: what the surgeon needs to know? J. Visc. Surg. 2016; 153: 109-112.
Meara JG, Leather AJ, Hagander L et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386: 569-624.
Weiser TG, Regenbogen SE, Thompson KD et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 2008; 372: 139-144.
McIsaac DI, Gill M, Boland L et al. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br. J. Anaesth. 2022; 128: 244-257.
Hughes MJ, Hackney RJ, Lamb PJ, Wigmore SJ, Christopher Deans D, Skipworth RJ. Prehabilitation before major abdominal surgery: a systematic review and meta-analysis. World J. Surg. 2019; 43: 1661-1668.
Falz R, Bischoff C, Thieme R et al. Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis. J. Cancer Res. Clin. Oncol. 2022; 148: 2187-2213.
Bruns E, van den Heuvel B, Buskens C et al. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis. 2016; 18: O267-O277.
Hijazi Y, Gondal U, Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery. Int. J. Surg. 2017; 39: 156-162.
Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clin. Rehabil. 2015; 29: 426-438.
Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst. Rev. 2022; 2022: 1189-1201.
Moran J, Guinan E, McCormick P et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery 2016; 160: 1189-1201.
Perry R, Herbert G, Atkinson C et al. Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis. BMJ Open 2021; 11: e050806.
Powell R, Scott NW, Manyande A et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst. Rev. 2016; 2016: CD008646.
Santa Mina D, Clarke H, Ritvo P et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy 2014; 100: 196-207.
Thomas G, Tahir MR, Bongers BC, Kallen VL, Slooter GD, van Meeteren NL. Prehabilitation before major intra-abdominal cancer surgery: a systematic review of randomised controlled trials. Eur. J. Anaesthesiol. 2019; 36: 933-945.
Royal Australasian College of Surgeons. Surgical Specialties. Edition [Cited 10 May 2023.] Available from URL: https://www.surgeons.org/en/Trainees/surgical-specialties
Li M, Bolshinsky V, Ismail H et al. A cross-sectional survey of Australian anesthetists' and surgeons' perceptions of preoperative risk stratification and prehabilitation. Can. J. Anaesth. 2019; 66: 388-405.
Page MJ, Moher D, Bossuyt PM et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372: n160.
Campbell M, McKenzie JE, Sowden A et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ 2020; 368: l6890.
Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med. Inform. Decis. Mak. 2007; 7: 1-6.
Bernardi K, Olavarria OA, Dhanani NH et al. Two-year outcomes of prehabilitation among obese patients with ventral hernias: a randomized controlled trial (NCT02365194). Ann. Surg. 2022; 275: 288-294.
Liang MK, Bernardi K, Holihan JL et al. Modifying risks in ventral hernia patients with prehabilitation: a randomized controlled trial. Ann. Surg. 2018; 268: 674-680.
Medina Sifuentes AM, Suarez Flores D, Hernandez VL. Effect of pre-habilitation on quality of life and post-operation fatigue syndrome in Medico Nacional-Leon IMSS de Leon Guanajuato. Rev. Hispanoam. de Hernia 2018; 6: 11-16.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst. Rev. 2016; 5: 210.
Sterne JA, Savović J, Page MJ et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.
Allen SK, Brown V, White D et al. Multimodal prehabilitation during neoadjuvant therapy prior to esophagogastric cancer resection: effect on cardiopulmonary exercise test performance, muscle mass and quality of life-a pilot randomized clinical trial. Ann. Surg. Oncol. 2021; 1-12: 1839-1850.
Bousquet-Dion G, Awasthi R, Loiselle S-È et al. Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial. Acta Oncol. 2018; 57: 849-859.
Carli F, Bousquet-Dion G, Awasthi R et al. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial. JAMA Surg. 2020; 155: 233-242.
Carli F, Charlebois P, Stein B et al. Randomized clinical trial of prehabilitation in colorectal surgery. J. Br. Surg. 2010; 97: 1187-1197.
Gloor S, Misirlic M, Frei-Lanter C et al. Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity: results of a single-center, blinded, randomized controlled trial. Langenbecks Arch. Surg. 2022; 407: 897-907.
Heiman J, Onerup A, Bock D, Haglind E, Olofsson BR. The effect of nonsupervised physical activity before and after breast cancer surgery on quality of life: results from a randomized controlled trial (PhysSURG-B). Scand. J. Surg. 2022; 111: 75-82.
Lemanu DP, Singh PP, Shao RY et al. Text messaging improves preoperative exercise in patients undergoing bariatric surgery. ANZ J. Surg. 2018; 88: 733-738.
Ligibel JA, Dillon D, Giobbie-Hurder A et al. Impact of a pre-operative exercise intervention on breast cancer proliferation and gene expression: results from the pre-operative health and body (PreHAB) study exercise window trial in newly diagnosed breast cancer. Clin. Cancer Res. 2019; 25: 5398-5406.
López-Rodríguez-Arias F, Sánchez-Guillén L, Aranaz-Ostáriz V et al. Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic. Support. Care Cancer 2021; 29: 7785-7791.
McIsaac DI, Hladkowicz E, Bryson GL et al. Home-based prehabilitation with exercise to improve postoperative recovery for older adults with frailty having cancer surgery: the PREHAB randomised clinical trial. Br. J. Anaesth. 2022; 129: 41-48.
Onerup A, Andersson J, Angenete E et al. Effect of short-term homebased pre-and postoperative exercise on recovery after colorectal cancer surgery (PHYSSURG-C): a randomized clinical trial. Ann. Surg. 2022; 275: 448-455.
Rengel KF, Mehdiratta N, Vanston SW et al. A randomised pilot trial of combined cognitive and physical exercise prehabilitation to improve outcomes in surgical patients. Br. J. Anaesth. 2021; 126: e55-e57.
Taha A, Taha-Mehlitz S, Staartjes VE et al. Association of a prehabilitation program with anxiety and depression before colorectal surgery: a post hoc analysis of the pERACS randomized controlled trial. Langenbecks Arch. Surg. 2021; 406: 1553-1561.
Valkenet K, Trappenburg J, Ruurda J et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. J. Br. Surg. 2018; 105: 502-511.
Barberan-Garcia A, Ubré M, Roca J et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann. Surg. 2018; 267(1): 50-56. https://doi.org/10.1097/SLA.0000000000002293
Berkel AE, Bongers BC, Kotte H et al. Effects of community-based exercise prehabilitation for patients scheduled for colorectal surgery with high risk for postoperative complications: results of a randomized clinical trial. Ann. Surg. 2022; 275: e299-e306.
Dunne D, Jack S, Jones R et al. Randomized clinical trial of prehabilitation before planned liver resection. J. Br. Surg. 2016; 103: 504-512.
Fulop A, Lakatos L, Susztak N, Szijarto A, Banky B. The effect of trimodal prehabilitation on the physical and psychological health of patients undergoing colorectal surgery: a randomised clinical trial. Anaesthesia 2021; 76: 82-90.
Gillis C, Li C, Lee L et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 2014; 121: 937-947.
Kim DJ, Mayo NE, Carli F, Montgomery DL, Zavorsky GS. Responsive measures to prehabilitation in patients undergoing bowel resection surgery. Tohoku J. Exp. Med. 2009; 217: 109-115.
Loughney L, West MA, Moyses H et al. The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients: a randomised controlled trial (the EMPOWER trial). Perioperative Med. 2021; 10: 1-12.
Minnella EM, Awasthi R, Loiselle S-E, Agnihotram RV, Ferri LE, Carli F. Effect of exercise and nutrition prehabilitation on functional capacity in esophagogastric cancer surgery: a randomized clinical trial. JAMA Surg. 2018; 153: 1081-1089.
Minnella EM, Ferreira V, Awasthi R et al. Effect of two different pre-operative exercise training regimens before colorectal surgery on functional capacity: a randomised controlled trial. Eur. J. Anaesthesiol. EJA 2020; 37: 969-978.
Peng L-H, Wang W-J, Chen J, Jin J-Y, Min S, Qin P-P. Implementation of the pre-operative rehabilitation recovery protocol and its effect on the quality of recovery after colorectal surgeries. Chin Med J (Engl) 2021; 134: 2865-2873.
Swaminathan N, Kundra P, Ravi R, Kate V. ERAS protocol with respiratory prehabilitation versus conventional perioperative protocol in elective gastrectomy-a randomized controlled trial. Int. J. Surg. 2020; 81: 149-157.
Waller E, Sutton P, Rahman S, Allen J, Saxton J, Aziz O. Prehabilitation with wearables versus standard of care before major abdominal cancer surgery: a randomised controlled pilot study (trial registration: NCT04047524). Surg. Endosc. 2022; 1-10: 1008-1017.
Woodfield JC, Clifford K, Wilson GA, Munro F, Baldi JC. Short-term high-intensity interval training improves fitness before surgery: a randomized clinical trial. Scand. J. Med. Sci. Sports 2022; 32: 856-865.
Yamana I, Takeno S, Hashimoto T et al. Randomized controlled study to evaluate the efficacy of a preoperative respiratory rehabilitation program to prevent postoperative pulmonary complications after esophagectomy. Dig. Surg. 2015; 32: 331-337.
Northgraves MJ, Arunachalam L, Madden LA et al. Feasibility of a novel exercise prehabilitation programme in patients scheduled for elective colorectal surgery: a feasibility randomised controlled trial. Support. Care Cancer 2020; 28: 3197-3206.
Moug S, Mutrie N, Barry S et al. Prehabilitation is feasible in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy and may minimize physical deterioration: results from the REx trial. Colorectal Dis. 2019; 21: 548-562.
Humeidan ML, Reyes J-PC, Mavarez-Martinez A et al. Effect of cognitive prehabilitation on the incidence of postoperative delirium among older adults undergoing major noncardiac surgery: the neurobics randomized clinical trial. JAMA Surg. 2021; 156: 148-156.
Koç MA, Akyol C, Gökmen D, Aydın D, Erkek BA, Kuzu MA. Effect of prehabilitation on stoma self-care, anxiety, depression and quality of life in stoma patients: a randomized controlled trial. Dis. Colon Rectum 2022; 66: 138-147.
Vlisides PE, Das AR, Thompson AM et al. Home-based cognitive prehabilitation in older surgical patients: a feasibility study. J. Neurosurg. Anesthesiol. 2019; 31: 212-217.
Ausania F, Senra P, Melendez R, Caballeiro R, Ouvina R, Casal-Nunez E. Prehabilitation in patients undergoing pancreaticoduodenectomy: a randomized controlled trial. Rev. Esp. Enferm. Dig. 2019; 111: 603-608.
Gillis C, Loiselle S-E, Fiore JF Jr et al. Prehabilitation with whey protein supplementation on perioperative functional exercise capacity in patients undergoing colorectal resection for cancer: a pilot double-blinded randomized placebo-controlled trial. J. Acad. Nutr. Diet. 2016; 116: 802-812.
Lambert JE, Hayes LD, Keegan TJ, Subar DA, Gaffney CJ. The impact of prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal cancer surgery: a PRISMA-accordant meta-analysis. Ann. Surg. 2021; 274: 70-77.
Herrera-Santelices A, Argüello-Florencio G, Westphal G, Nardo Junior N, Zamunér AR. Effects of supervised physical exercise as Prehabilitation on body composition, functional capacity and quality of life in bariatric surgery candidates: a systematic review and meta-analysis. J. Clin. Med. 2022; 11: 5091.
Elwyn G, Frosch D, Thomson R et al. Shared decision making: a model for clinical practice. J. Gen. Intern. Med. 2012; 27: 1361-1367.
Kovoor JG, Bacchi S, Gupta AK, O'Callaghan PG, Abou-Hamden A, Maddern GJ. Artificial intelligence clinical trials and critical appraisal: a necessity. ANZ J. Surg. 2023; 93: 1141-1142.
Kovoor JG, Bacchi S, Gupta AK et al. The Adelaide score: an artificial intelligence measure of readiness for discharge after general surgery. ANZ J. Surg. 2023; 93: 2119-2124.
Lam A, Squires E, Tan S et al. Artificial intelligence for predicting acute appendicitis: a systematic review. ANZ J. Surg. 2023; 93: 2070-2078.
Stam WT, Goedknegt LK, Ingwersen EW, Schoonmade LJ, Bruns ER, Daams F. The prediction of surgical complications using artificial intelligence in patients undergoing major abdominal surgery: a systematic review. Surgery 2022; 171: 1014-1021.
Piette JD, Newman S, Krein SL et al. Patient-centered pain care using artificial intelligence and mobile health tools: a randomized comparative effectiveness trial. JAMA Intern. Med. 2022; 182: 975-983.
Hassan AM, Rajesh A, Asaad M et al. Artificial intelligence and machine learning in prediction of surgical complications: current state, applications, and implications. Am. Surg. 2023; 89: 25-30.
Loftus TJ, Tighe PJ, Filiberto AC et al. Artificial intelligence and surgical decision-making. JAMA Surg. 2020; 155: 148-158.
Ayers JW, Poliak A, Dredze M et al. Comparing physician and artificial intelligence chatbot responses to patient questions posted to a public social media forum. JAMA Intern. Med. 2023; 183: 589.