Effect of prehabilitation on outcomes following upper gastrointestinal surgery: a systematic review and meta-analysis

Nicholas Findlay; Sean Han; Neil Pillinger

doi:10.18203/2349-2902.isj20243546

Authors

Nicholas Findlay Department of Surgery, Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia https://orcid.org/0009-0008-3598-3541
Sean Han Nepean Hospital, Penrith, NSW Australia
Neil Pillinger Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20243546

Keywords:

Prehabilitation, Upper GI surgery, Inspiratory muscle training, Pulmonary complications

Abstract

It is accepted in several areas of surgery that prehabilitation can improve post-operative outcomes. Prehabilitation describes preoperative interventions aimed at optimizing patient condition prior to surgery to improve postoperative outcomes. It is hypothesized that prehabilitation reduces postoperative complications in the setting of upper gastrointestinal surgery. A systematic search strategy was performed based on a research question formulated with reference to the PICO framework. Eligible studies were those that included a predefined prehabilitation intervention, a comparison to usual care and conducted on patients undergoing upper gastrointestinal surgery. Included studies were evaluated for bias and underwent data extraction. Meta-analysis was also performed for outcomes where possible. Eight studies met criteria for inclusion in this review. The nature and length of prehabilitation programs varied widely, with interventions lasting from two to six weeks. Reported outcomes included post-operative pulmonary complications, mortality and length of hospital stay. A meta-analysis was undertaken for mortality and postoperative pulmonary complications. Meta-analysis showed postoperative pulmonary complications were reduced (RR0.68, 95% CI 0.50-0.93) in the intervention group compared to the control group, as was mortality (RR 0.59, 95% CI 0.35-1.00). Prehabilitation, especially inspiratory muscle training appears to be effective in reducing pulmonary complications in patients scheduled for upper gastrointestinal surgery. With the available data it is uncertain if this translates to reduced length of stay or mortality. There is scope for further research to better define a role for prehabilitation in upper gastrointestinal surgery, specifically the optimal prehabilitation modality and length.

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