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The Impact of Total Body Prehabilitation on Post-Operative Outcomes After Major Abdominal Surgery: A Systematic Review

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Abstract

Background

Despite advances in perioperative care, post-operative clinical and functional outcomes after major abdominal surgery can be suboptimal. Prehabilitation programmes attempt to optimise a patient’s preoperative condition to improve outcomes. Total body prehabilitation includes structured exercise, nutritional optimisation, psychological support and cessation of negative health behaviours. This systematic review aims to report on the current literature regarding the impact of total body prehabilitation prior to major abdominal surgery.

Methods

Relevant studies published between January 2000 and July 2017 were identified using MEDLINE, EMBASE, AMED, CINAHL, PsychINFO, PubMed, and the Cochrane Database. All studies published in a peer-reviewed journal, assessing post-operative clinical and functional outcomes, following a prehabilitation programme prior to major abdominal surgery were included. Studies with less than ten patients, or a prehabilitation programme lasting less than 7 days were excluded.

Results

Sixteen studies were included, incorporating 2591 patients, with 1255 undergoing a prehabilitation programme. The studies were very heterogeneous, with multiple surgical sub-specialties, prehabilitation techniques, and outcomes assessed. Post-operative complication rate was reduced in six gastrointestinal studies utilising either preoperative exercise, nutritional supplementation in malnourished patients or smoking cessation. Improved functional outcomes were observed following a multimodal prehabilitation programme. Compliance was variably measured across the studies (range 16–100%).

Conclusions

There is substantial heterogeneity in the prehabilitation programmes used prior to major abdominal surgery. A multimodal approach is likely to have better impact on functional outcomes compared to single modality; however, there is insufficient data either to identify the optimum programme, or to recommend routine clinical implementation.

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Author information

Authors and Affiliations

  1. Department of General Surgery, Dorset County Hospital NHS Foundation Trust, Williams Avenue, Dorchester, DT1 2JY, UK

    Alison Luther

  2. Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Castle Lane East, Bournemouth, BH7 7DW, UK

    Joseph Gabriel

  3. University of Bristol, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK

    Richard P. Watson

  4. Clinical Research Unit, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK

    Nader K. Francis

  5. University of Bath, Wessex House 3.22, Bath, BA2 7JU, UK

    Nader K. Francis

Authors
  1. Alison Luther
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  2. Joseph Gabriel
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  3. Richard P. Watson
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  4. Nader K. Francis
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Corresponding author

Correspondence to Nader K. Francis.

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Luther, A., Gabriel, J., Watson, R.P. et al. The Impact of Total Body Prehabilitation on Post-Operative Outcomes After Major Abdominal Surgery: A Systematic Review. World J Surg 42, 2781–2791 (2018). https://doi.org/10.1007/s00268-018-4569-y

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  • DOI: https://doi.org/10.1007/s00268-018-4569-y

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