Kehler D Scott, Stammers Andrew N, Tangri Navdeep, Hiebert Brett, Fransoo Randy, Schultz Annette S H, Macdonald Kerry, Giacomontonio Nicholas, Hassan Ansar, Légaré Jean-Francois, Arora Rakesh C, Duhamel Todd A
Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada.
BMJ Open. 2017 Aug 11;7(8):e015712. doi: 10.1136/bmjopen-2016-015712.
The objective of this systematic review was to study the impact of preoperative physical activity levels on adult cardiac surgical patients' postoperative: (1) major adverse cardiac and cerebrovascular events (MACCEs), (2) adverse events within 30 days, (3) hospital length of stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5) activities of daily living (ADLs), (6) quality of life, (7) cardiac rehabilitation attendance and (8) physical activity behaviour.
A systematic search of MEDLINE, Embase, AgeLine and Cochrane library for cohort studies was conducted.
Eleven studies (n=5733 patients) met the inclusion criteria. Only self-reported physical activity tools were used. Few studies used multivariate analyses to compare active versus inactive patients prior to surgery. When comparing patients who were active versus inactive preoperatively, there were mixed findings for MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that adjusted for confounding variables, five studies found a protective, independent association between physical activity and MACCE (n=1), 30-day postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies found no protective association for 30-day postoperative events (n=1) and postoperative ADLs (n=1). No studies investigated if activity status before surgery impacted quality of life or cardiac rehabilitation attendance postoperatively. Three studies found that active patients prior to surgery were more likely to be inactive postoperatively.
Due to the mixed findings, the literature does not presently support that self-reported preoperative physical activity behaviour is associated with postoperative cardiac surgical outcomes. Future studies should objectively measure physical activity, clearly define outcomes and adjust for clinically relevant variables.
Trial registration number NCT02219815. PROSPERO number CRD42015023606.
本系统评价的目的是研究术前身体活动水平对成年心脏手术患者术后的影响：（1）主要不良心脑血管事件（MACCE）；（2）30天内的不良事件；（3）住院时间（HLOS）；（4）重症监护病房住院时间（ICU LOS）；（5）日常生活活动能力（ADL）；（6）生活质量；（7）心脏康复参与情况；（8）身体活动行为。
对MEDLINE、Embase、AgeLine和Cochrane图书馆进行系统检索，以查找队列研究。
11项研究（n = 5733例患者）符合纳入标准。仅使用了自我报告的身体活动工具。很少有研究使用多变量分析来比较手术前活动与不活动的患者。在比较术前活动与不活动的患者时，关于MACCE、30天不良事件、HLOS和ICU LOS的研究结果不一。在对混杂变量进行调整的研究中，五项研究发现身体活动与MACCE（n = 1）、术后30天事件（n = 2）、HLOS（n = 1）和ICU LOS（n = 1）之间存在保护性的独立关联，但两项研究发现术后30天事件（n = 1）和术后ADL（n = 1）不存在保护性关联。没有研究调查术前活动状态是否会影响术后生活质量或心脏康复参与情况。三项研究发现术前活跃的患者术后更有可能不活跃。
由于研究结果不一，目前文献不支持自我报告的术前身体活动行为与心脏手术后的结果相关。未来的研究应客观地测量身体活动，明确界定结果，并对临床相关变量进行调整。注册：试验注册号NCT02219815。PROSPERO编号CRD42015023606。
