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Multimodal prehabilitation in older adults before major abdominal surgery: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
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Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Multimodal prehabilitation aims to prepare frail older patients for major surgery. The objective of this review is to determine the benefits of pre-operative multimodal prehabilitation compared to standard care in older patients.

Methods

Data sources included MEDLINE, EMBASE, CENTRAL, CINAHL and PsychINFO. They were searched from inception to September 2021. Only randomized controlled trials (RCT) with an average study population age ≥ 65 that had undergone major abdominal operation with at least two components (physical, nutritional, psychological) of prehabilitation programs were included.

Results

Nine RCTs were included with a total of 823 patients, of whom 705 completed the study with 358 undergoing prehabilitation and 347 were controls. Significantly lower complications were observed in the prehabilitation group compared to control (OR 0.67; 95% CI 0.46 to 0.99; p = 0.04; I2 = 32%). A significant increase in 6-min walking distance (6MWD) from baseline to immediately prior to surgery (mean difference 35.1 m; 95%CI 11.6–58.4; p = 0.003; I2 = 67%) and 8 weeks post-surgery (mean difference 44.9 m; 95%CI 6.0–83.8; p = 0.02; I2 = 75%) was noted in the prehabilitation group. No difference was observed in length of stay (OR 0.59; 95% CI − 0.23 to 1.40; p = 0.16; I2 = 91%) or 30-day emergency department visit (OR 0.72; 95% CI 0.41 to 1.26; p = 0.25; I2 = 0%). Patient reported outcome measures were not significantly different.

Conclusions

Amongst older patients, multimodal prehabilitation increases peri-operative functional capacity and may potentially decrease post-operative complications. Future studies should continue to focus on older patients who are frail as this is the group that prehabilitation would likely have a clinically significant impact on.

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Author information

Authors and Affiliations

  1. Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, National University Health System, 1E, Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore

    Ning Qi Pang, Glenn Kunnath Bonney & Wei Chieh Alfred Kow

  2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Yu Xiang Tan, Miny Samuel, Ker-Kan Tan & Wei Chieh Alfred Kow

  3. Division of Colorectal Surgery, Department of Surgery, National University Hospital, National University Health System, Singapore, Singapore

    Ker-Kan Tan

  4. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Huso Yi

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  1. Ning Qi Pang
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Contributions

NQP is the first author of this paper and was involved in the study design, acquisition of data, analysis and interpretation of data, writing up of the first draft of the paper and critical revision of manuscript. YXT is the second author of this paper and was involved in the study design, acquisition of data, analysis and interpretation of data and critical revision of manuscript. MS was involved in the study design, acquisition of data, analysis and interpretation of data and critical revision of manuscript. KKT, GKB and HY were involved in the study design, analysis and interpretation of data and critical revision of manuscript. WCAK is the senior author of this paper and was involved in the study design, analysis and interpretation of data and critical revision of manuscript.

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Correspondence to Ning Qi Pang.

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Pang, N.Q., Tan, Y.X., Samuel, M. et al. Multimodal prehabilitation in older adults before major abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 407, 2193–2204 (2022). https://doi.org/10.1007/s00423-022-02479-8

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