Department of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
School of Psychology and Cognitive Science, Peking University, Beijing, 100871, People's Republic of China.
Aging Clin Exp Res. 2022 Mar;34(3):485-494. doi: 10.1007/s40520-021-01929-5. Epub 2021 Jul 5.
To determine the postoperative effectiveness of trimodal prehabilitation in older surgical patients.
We searched Medline, PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov for observational cohort studies and randomised controlled trials (RCTs) of older surgical patients who underwent trimodal prehabilitation. We performed a meta-analysis to estimate the pooled risk ratio (RR) for dichotomous data and weighted mean difference (MD) for continuous data. Primary outcomes were postoperative mortality and complications, and the secondary outcomes were the 6-min walk test (6MWT) at 4 and 8 weeks after surgery, readmission, and length of hospital stay (LOS). This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42020201347).
We included 10 studies (four RCTs and six cohort studies) comprising 1553 older surgical patients (trimodal prehabilitation group, n = 581; control group, n = 972). There were no significant differences in postoperative mortality (RR 1.32; 95% confidence interval [CI] 0.52-3.35) and postoperative complications (RR 0.91; 95% CI 0.76-1.09). Prehabilitation did not reduce readmission (RR 0.92; 95% CI 0.61-1.38) and LOS (MD 0.10; 95% CI - 0.34-0.53). In a sub-analysis, trimodal prehabilitation did not significantly improve postoperative mortality, postoperative complications, readmission rates, or LOS when compared with standard care. However, trimodal prehabilitation significantly improved the 6MWT at 4 weeks after surgery (MD 37.49; 95% CI 5.81-69.18).
Our systematic review and meta-analysis demonstrated that trimodal prehabilitation did not reduce postoperative mortality and complications significantly but improved postoperative functional status in older surgical patients. Therefore, more high-quality trials are required.
确定多模式术前康复对老年手术患者的术后效果。
我们检索了 Medline、PubMed、Embase、Cochrane 图书馆、Web of Science 和 ClinicalTrials.gov，以获取接受多模式术前康复的老年手术患者的观察性队列研究和随机对照试验（RCT）。我们进行了荟萃分析，以估计二分类数据的合并风险比（RR）和连续数据的加权均数差（MD）。主要结局是术后死亡率和并发症，次要结局是术后 4 周和 8 周的 6 分钟步行试验（6MWT）、再入院和住院时间（LOS）。本系统评价和荟萃分析已在 PROSPERO（注册号：CRD42020201347）中注册。
我们纳入了 10 项研究（4 项 RCT 和 6 项队列研究），共纳入 1553 名老年手术患者（多模式术前康复组，n=581；对照组，n=972）。术后死亡率（RR 1.32；95%置信区间 [CI] 0.52-3.35）和术后并发症（RR 0.91；95% CI 0.76-1.09）无显著差异。术前康复并未降低再入院率（RR 0.92；95% CI 0.61-1.38）和 LOS（MD 0.10；95% CI -0.34-0.53）。在亚分析中，与标准护理相比，多模式术前康复并未显著改善术后死亡率、术后并发症、再入院率或 LOS，但显著改善了术后 4 周的 6MWT（MD 37.49；95% CI 5.81-69.18）。
本系统评价和荟萃分析表明，多模式术前康复并未显著降低老年手术患者的术后死亡率和并发症，但改善了术后功能状态。因此，需要更多高质量的试验。
