一项系统评价和荟萃分析高质量随机对照试验，评估术前康复方案在结直肠手术中的作用。

A systematic review and meta-analysis of high-quality randomized controlled trials on the role of prehabilitation programs in colorectal surgery.

机构信息

Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. Electronic address: https://www.twitter.com/ZGaroufalia.

Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Egypt. Electronic address: https://www.twitter.com/dr_samehhany81.

出版信息

Surgery. 2024 Nov;176(5):1352-1359. doi: 10.1016/j.surg.2024.07.009. Epub 2024 Aug 15.

DOI:10.1016/j.surg.2024.07.009

PMID:39147666

Abstract

BACKGROUND

Prehabilitation is gaining popularity in colorectal surgery but lacks high-quality postoperative outcomes data. This meta-analysis explored whether prehabilitation impacts postoperative outcomes.

METHODS

In this meta-analysis, compliant with Preferred Reporting Items for Systematic reviews and Meta-Analyses, we searched PubMed and Scopus through November 2022. High-quality randomized control trials involving adults who underwent colorectal surgery with/without exercise-based prehabilitation were included. The main outcomes were short-term postoperative morbidity, readmissions, and length of stay. Random-effect meta-analyses were performed, and statistical heterogeneity was assessed using the I statistic.

RESULTS

Seven high-quality randomized control trials comprising 1,225 patients were included. The median prehabilitation duration was 4 (2-4) weeks. Four studies compared prehabilitation and standard of care, and 3 compared prehabilitation and rehabilitation. Exercise-based prehabilitation did not reduce the odds of short-term complications (odds ratio 0.62, 95% confidence interval 0.27-1.40, P = .25, I = 68%) or readmission (odds ratio 1, 95% confidence interval 0.73-1.46, P = .85, I = 0%). The prehabilitation group had shorter length of hospital stay (weighted mean difference -0.2, 95% confidence interval -0.25 to -0.14, P < .0001, I = 43.3%). Prehabilitation and rehabilitation had similar odds of short-term complications (odds ratio 1.03, 95% confidence interval 0.56-1.89, P = .91, I = 33%), length of stay (weighted mean difference -0.16, 95% confidence interval -0.47 to 0.16, P = .33, I = 59%), and readmission (odds ratio 1.25, 95% confidence interval 0.28-5.56, P = .77, I = 52%). The only benefit of prehabilitation over rehabilitation was better 6-minute walking distance test results at time of surgery (weighted mean difference: -9.4 m; 95% confidence interval -18.04 to 0.79, P = .03, I = 42%).

CONCLUSION

Prehabilitation provided decreased postoperative length of hospital stay and improved preoperative functional outcomes, but not reduced odds of complications and/or readmissions. Prehabilitation and rehabilitation had similar clinical outcomes.

摘要

背景

术前康复在结直肠手术中越来越受欢迎，但缺乏高质量的术后结局数据。本荟萃分析旨在探讨术前康复是否对术后结局产生影响。

方法

本荟萃分析遵循系统评价和荟萃分析的首选报告项目，检索了 2022 年 11 月前的 PubMed 和 Scopus 数据库。纳入了涉及接受结直肠手术并接受/未接受基于运动的术前康复的成年人的高质量随机对照试验。主要结局是短期术后发病率、再入院和住院时间。采用随机效应荟萃分析，使用 I ²统计评估统计异质性。

结果

纳入了 7 项高质量的随机对照试验，共纳入 1225 名患者。术前康复的中位数持续时间为 4 （2-4）周。4 项研究比较了术前康复与标准护理，3 项研究比较了术前康复与康复。基于运动的术前康复并不能降低短期并发症的几率（比值比 0.62，95%置信区间 0.27-1.40，P=0.25，I=68%）或再入院率（比值比 1，95%置信区间 0.73-1.46，P=0.85，I=0%）。术前康复组的住院时间更短（加权均数差-0.2，95%置信区间-0.25 至-0.14，P<0.0001，I=43.3%）。术前康复和康复的短期并发症发生率（比值比 1.03，95%置信区间 0.56-1.89，P=0.91，I=33%）、住院时间（加权均数差-0.16，95%置信区间-0.47 至 0.16，P=0.33，I=59%）和再入院率（比值比 1.25，95%置信区间 0.28-5.56，P=0.77，I=52%）相似。术前康复唯一优于康复的是手术时 6 分钟步行试验结果更好（加权均数差：-9.4 m；95%置信区间-18.04 至 0.79，P=0.03，I=42%）。