Institute of Cellular Medicine, University of Newcastle, Newcastle-Upon-Tyne, United Kingdom; Department of Hepatobiliary, Pancreatic, and Transplant Surgery, Freeman Hospital, Newcastle University Trust Hospitals, Newcastle-Upon-Tyne, United Kingdom.
College of Medical and Dental Sciences, University of Birmingham, United Kingdom.
Surgery. 2020 Mar;167(3):540-549. doi: 10.1016/j.surg.2019.07.032. Epub 2019 Sep 20.
There has been increasing interest in the prehabilitation of patients undergoing major abdominal surgery to improve perioperative outcomes. This systematic review and meta-analysis aims to evaluate and compare the current literature on prehabilitation in major abdominal surgery and cardiothoracic surgery METHODS: A systematic literature search was conducted for studies reporting prehabilitation in patients undergoing major abdominal and cardiothoracic surgery. Meta-analysis of postoperative outcomes (overall and major complications, pulmonary and cardiac complications, postoperative pneumonia, and length of hospital stay) was performed using random effects models.
Five thousand nine hundred and twenty-one patients underwent prehabilitation in 61 studies, of which 35 studies (n = 3,402) were in major abdominal surgery and 26 studies were in cardiothoracic surgery (n = 2,519). Only 45 studies compared the impact of prehabilitation versus no prehabilitation on postoperative outcomes (abdominal, n = 26; cardiothoracic, n = 19). Quality of evidence for prehabilitation in major abdominal and cardiothoracic surgery appear equivalent. Patients receiving prehabilitation for major abdominal surgery have significantly lower rates of overall (n = 10, odds ratio: 0.61, confidence interval 95%: 0.43-0.86, P = .005), pulmonary (n = 15, odds ratio: 0.41, confidence interval 95%: 0.25-0.67, P < .001), and cardiac complications (n = 4, odds ratio: 0.46, confidence interval 95%: 0.22-0.96, P = .044). Sensitivity analysis including randomized controlled trials only did not alter the findings of this study.
Prehabilitation has the potential to improve surgical outcomes in patients undergoing major abdominal and cardiothoracic surgery. However, current evidence from randomized studies remains weak owing to variation in prehabilitation regimes, limiting the assessment of current postoperative outcomes.
人们对接受大腹部手术的患者进行术前康复以改善围手术期结局的兴趣日益增加。本系统评价和荟萃分析旨在评估和比较大腹部手术和心胸外科手术中术前康复的现有文献。
对报告大腹部和心胸外科手术患者术前康复的研究进行系统文献检索。使用随机效应模型对术后结局（总体和主要并发症、肺部和心脏并发症、术后肺炎和住院时间）进行荟萃分析。
61 项研究中有 5921 名患者接受了术前康复治疗，其中 35 项研究（n=3402）为大腹部手术，26 项研究为心胸外科手术（n=2519）。只有 45 项研究比较了术前康复与无术前康复对术后结局的影响（腹部，n=26；心胸外科，n=19）。大腹部和心胸外科手术术前康复的证据质量似乎相当。接受大腹部手术术前康复的患者总体并发症发生率显著降低（n=10，比值比：0.61，95%置信区间：0.43-0.86，P=0.005）、肺部并发症发生率显著降低（n=15，比值比：0.41，95%置信区间：0.25-0.67，P<.001）和心脏并发症发生率显著降低（n=4，比值比：0.46，95%置信区间：0.22-0.96，P=0.044）。仅包括随机对照试验的敏感性分析并未改变本研究的发现。
术前康复有可能改善接受大腹部和心胸外科手术的患者的手术结局。然而，由于术前康复方案的差异，来自随机研究的现有证据仍然薄弱，限制了对当前术后结局的评估。
