Hall Anne E, Nguyen Nghiem H, Cascavita Catherine T, Shariati Kaavian, Patel Archi K, Chen Wei, Kang Youngnam, Ren Xiaoyan, Tseng Chi-Hong, Hidalgo Marco A, Lee Justine C
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Los Angeles, David Geffen School of Medicine and the Greater Los Angeles VA Healthcare System, Los Angeles, CA.
Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
Ann Surg. 2025 Jun 1;281(6):928-941. doi: 10.1097/SLA.0000000000006677. Epub 2025 Feb 19.
To investigate the efficacy of psychological prehabilitation in improving surgical outcomes.
Prehabilitation aims to improve surgical outcomes through prevention. While most prehabilitation protocols have focused on improving patient knowledge and physical function, mental health has started to receive greater attention due to its effects on postoperative recovery, including persistent opioid use. However, the efficacy of psychological prehabilitation remains unclear due to the heterogeneity of psychological modalities, intervention characteristics, and surgical contexts.
A systematic review, meta-analysis, and meta-regression of randomized controlled trials from 2004 to 2024 were conducted per "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines to assess the effect of psychotherapy on 4 postoperative outcomes: length of stay (LOS), pain, anxiety, and depression. Randomized controlled trials were retrieved from MEDLINE, EMBASE, CENTRAL, and Google Scholar databases (March 2024). Studies with >50 adult surgical patients were included. Random effect meta-analyses estimated pooled effect sizes, with meta-regression analyzing intervention and surgery types.
Twenty articles comprising 2376 patients were included. Psychological prehabilitation interventions included cognitive behavioral therapy (70%), supportive psychotherapy (25%), and acceptance and commitment therapy (5%). Pooled analysis revealed greater reductions in LOS [mean difference (MD) = -1.62 days; 95% CI: -2.899, -0.349; P = 0.012], pain (MD = -3.52; 95% CI: -2.642, -4.401; P < 0.001), anxiety (standard MD = -1.51; 95% CI: -0.634, -2.385; P < 0.001), and depression (standard MD = -1.48; 95% CI: -0.578, -2.382; P = 0.001). Psychotherapy modality and surgery type showed no significant effects, except for anxiety.
Psychological prehabilitation reduces LOS, pain, anxiety, and depression after surgery. Further studies are necessary to compare different types, durations, and delivery methods of psychotherapy for specific postoperative outcomes of interest.
探讨心理预康复对改善手术结局的疗效。
预康复旨在通过预防来改善手术结局。虽然大多数预康复方案都侧重于提高患者的知识水平和身体功能，但由于心理健康对术后恢复的影响，包括持续使用阿片类药物，心理健康开始受到更多关注。然而，由于心理治疗方式、干预特征和手术背景的异质性，心理预康复的疗效仍不明确。
根据“系统评价和Meta分析的首选报告项目”指南，对2004年至2024年的随机对照试验进行系统评价、Meta分析和Meta回归，以评估心理治疗对4个术后结局的影响：住院时间（LOS）、疼痛、焦虑和抑郁。从MEDLINE、EMBASE、CENTRAL和谷歌学术数据库（2024年3月）中检索随机对照试验。纳入成年手术患者超过50例的研究。随机效应Meta分析估计合并效应量，Meta回归分析干预和手术类型。
纳入20篇文章，共2376例患者。心理预康复干预包括认知行为疗法（70%）、支持性心理治疗（25%）和接受与承诺疗法（5%）。汇总分析显示，住院时间显著缩短[平均差（MD）=-1.62天；95%置信区间：-2.899，-0.349；P=0.012]，疼痛（MD=-3.52；95%置信区间：-2.642，-4.401；P<0.001），焦虑（标准MD=-1.51；95%置信区间：-0.634，-2.385；P<0.001）和抑郁（标准MD=-1.48；95%置信区间：-0.578，-2.382；P=0.001）。除焦虑外，心理治疗方式和手术类型未显示出显著影响。
心理预康复可缩短术后住院时间、减轻疼痛、缓解焦虑和抑郁。有必要进一步研究以比较不同类型、持续时间和实施方式的心理治疗对特定感兴趣的术后结局的影响。
