Department of Surgery, Houston Methodist, Houston, TX, USA.
Office of Faculty and Research Development, Department of Academic Affairs, Houston Methodist, Houston, TX, USA.
Sci Rep. 2024 Jul 11;14(1):16012. doi: 10.1038/s41598-024-66633-6.
The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran's Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (- 0.38 [- 0.75- - 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (- 0.96 [- 1.38- - 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (- 0.91 [- 1.67- - 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.
多模式术前康复对上腹部手术术后并发症的影响研究较少。本综述分析了多模式术前康复对患者和医院结局的随机试验。对择期（非紧急）腹部手术前的术前康复试验，我们检索了 MEDLINE、Embase、CINAHL 和 Cochrane CENTRAL。两位审查员独立筛选研究、提取数据并评估研究质量。主要结局为术后肺部并发症（PPC）和所有原因并发症；次要结局包括住院和重症监护病房的住院时间。使用随机效应模型进行了荟萃分析，并使用 I 平方和 Cochran Q 检验评估了异质性。二分类变量以对数优势比报告，连续变量以均数差表示。纳入了 10 项研究（共 1503 例患者）。与各种对照组相比，术前康复后发生并发症的几率显著降低（-0.38 [-0.75- -0.004]，P=0.048）。有 5 项研究描述了 PPC，术前康复组 PPC 的几率降低（-0.96 [-1.38- -0.54]，P<0.001）。术前康复并没有显著缩短住院时间，除非进行了运动；进行运动后，住院时间显著缩短（-0.91 [-1.67- -0.14]，P=0.02）。多模式术前康复可能会降低上腹部手术的并发症，但不一定会缩短住院时间；研究应解决文献中的异质性问题。
