Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic; 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic. Electronic address: https://twitter.com/PavelSkorepa.
Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada; Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Canada. Electronic address: https://twitter.com/KathFord_RD.
Clin Nutr. 2024 Mar;43(3):629-648. doi: 10.1016/j.clnu.2024.01.020. Epub 2024 Jan 22.
BACKGROUND & AIMS: Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes. The aim of this systematic review and meta-analysis was to determine the impact of prehabilitation on postoperative outcomes in frail and high-risk patients undergoing major abdominal surgery.
Embase, Medline, CINAHAL and Cochrane databases were searched from January 2010 to January 2023 for randomised clinical trials (RCTs) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes. Meta-analysis was limited to length of stay (primary end point), severe postoperative complications (Clavien-Dindo Classification ≥ Grade 3) and the 6-minute walk test (6MWT). The analysis was performed using RevMan v5.4 software.
Sixteen studies (6 RCTs, 10 observational) reporting on 3339 patients (1468 prehabilitation group, 1871 control group) were included. The median (interquartile range) age was 74.0 (71.0-78.4) years. Multimodal prehabilitation was applied in fifteen studies and unimodal in one. Meta-analysis of nine studies showed a reduction in hospital length of stay (weighted mean difference -1.07 days, 95 % CI -1.60 to -0.53 days, P < 0.0001, I = 19 %). Ten studies addressed severe complications and a meta-analysis suggested a decline in occurrence by up to 44 % (odds ratio 0.56, 95 % CI 0.37 to 0.82, P < 0.004, I = 51 %). Four studies provided data on preoperative 6MWT. The pooled weighted mean difference was 40.1 m (95 % CI 32.7 to 47.6 m, P < 0.00001, I = 24 %), favouring prehabilitation.
Given the significant impact on shortening length of stay and reducing severe complications, prehabilitation should be encouraged in frail, older and high-risk adult patients undergoing major abdominal surgery.
术前康复包括多学科术前干预，包括旨在改善手术结果的运动、营养优化和心理准备。本系统评价和荟萃分析的目的是确定在接受大型腹部手术的虚弱和高危患者中，术前康复对术后结果的影响。
从 2010 年 1 月至 2023 年 1 月，检索 Embase、Medline、CINAHAL 和 Cochrane 数据库，以评估单一模式（运动）或多模式术前康复计划的随机临床试验（RCT）和观察性研究。荟萃分析仅限于住院时间（主要终点）、严重术后并发症（Clavien-Dindo 分级≥3 级）和 6 分钟步行试验（6MWT）。分析使用 RevMan v5.4 软件进行。
纳入了 16 项研究（6 项 RCT，10 项观察性研究），共 3339 名患者（1468 名术前康复组，1871 名对照组）。中位数（四分位距）年龄为 74.0（71.0-78.4）岁。15 项研究采用多模式术前康复，1 项采用单一模式。9 项研究的荟萃分析显示，住院时间缩短（加权均数差-1.07 天，95%CI-1.60 至-0.53 天，P<0.0001，I²=19%）。10 项研究涉及严重并发症，荟萃分析表明发生率下降了多达 44%（比值比 0.56，95%CI 0.37 至 0.82，P<0.004，I²=51%）。4 项研究提供了术前 6MWT 的数据。合并的加权均数差为 40.1m（95%CI 32.7 至 47.6m，P<0.00001，I²=24%），有利于术前康复。
鉴于术前康复对缩短住院时间和减少严重并发症有显著影响，因此应鼓励虚弱、年龄较大和高危的成年患者在接受大型腹部手术前进行术前康复。
