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Trimodal prehabilitation for older surgical patients: a systematic review and meta-analysis

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Abstract

Objective

To determine the postoperative effectiveness of trimodal prehabilitation in older surgical patients.

Methods

We searched Medline, PubMed, Embase, the Cochrane Library, Web of Science, and ClinicalTrials.gov for observational cohort studies and randomised controlled trials (RCTs) of older surgical patients who underwent trimodal prehabilitation. We performed a meta-analysis to estimate the pooled risk ratio (RR) for dichotomous data and weighted mean difference (MD) for continuous data. Primary outcomes were postoperative mortality and complications, and the secondary outcomes were the 6-min walk test (6MWT) at 4 and 8 weeks after surgery, readmission, and length of hospital stay (LOS). This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42020201347).

Results

We included 10 studies (four RCTs and six cohort studies) comprising 1553 older surgical patients (trimodal prehabilitation group, n = 581; control group, n = 972). There were no significant differences in postoperative mortality (RR 1.32; 95% confidence interval [CI] 0.52–3.35) and postoperative complications (RR 0.91; 95% CI 0.76–1.09). Prehabilitation did not reduce readmission (RR 0.92; 95% CI 0.61–1.38) and LOS (MD 0.10; 95% CI  – 0.34–0.53). In a sub-analysis, trimodal prehabilitation did not significantly improve postoperative mortality, postoperative complications, readmission rates, or LOS when compared with standard care. However, trimodal prehabilitation significantly improved the 6MWT at 4 weeks after surgery (MD 37.49; 95% CI 5.81–69.18).

Conclusions

Our systematic review and meta-analysis demonstrated that trimodal prehabilitation did not reduce postoperative mortality and complications significantly but improved postoperative functional status in older surgical patients. Therefore, more high-quality trials are required.

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References

  1. Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144. https://doi.org/10.1016/s0140-6736(08)60878-8

    Article  PubMed  Google Scholar 

  2. Wynter-Blyth V, Moorthy K (2017) Prehabilitation: preparing patients for surgery. BMJ 358:j3702. https://doi.org/10.1136/bmj.j3702

    Article  PubMed  Google Scholar 

  3. Lawrence VA, Hazuda HP, Cornell JE et al (2004) Functional independence after major abdominal surgery in the elderly. J Am Coll Surg 199:762–772. https://doi.org/10.1016/j.jamcollsurg.2004.05.280

    Article  PubMed  Google Scholar 

  4. Aucoin S, McIsaac D (2019) Emergency general surgery in older adults: a review. Anesthesiol Clin 37:493–505. https://doi.org/10.1016/j.anclin.2019.04.008

    Article  PubMed  Google Scholar 

  5. Volkert D, Beck AM, Cederholm T et al (2019) ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 38:10–47. https://doi.org/10.1016/j.clnu.2018.05.024

    Article  PubMed  Google Scholar 

  6. Levett DZ, Edwards M, Grocott M, Mythen M (2016) Preparing the patient for surgery to improve outcomes. Best Pract Res Clin Anaesthesiol 30:145–157. https://doi.org/10.1016/j.bpa.2016.04.002

    Article  PubMed  Google Scholar 

  7. Levett DZH, Grimmett C (2019) Psychological factors, prehabilitation and surgical outcomes: evidence and future directions. Anaesthesia 74(Suppl 1):36–42. https://doi.org/10.1111/anae.14507

    Article  PubMed  Google Scholar 

  8. Mavros MN, Athanasiou S, Gkegkes ID et al (2011) Do psychological variables affect early surgical recovery? PLoS ONE 6:e20306. https://doi.org/10.1371/journal.pone.0020306

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Robinson TN, Wu DS, Pointer L et al (2013) Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 206:544–550. https://doi.org/10.1016/j.amjsurg.2013.03.012

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhu M, Wei J, Chen W et al (2017) Nutritional Risk and Nutritional Status at Admission and Discharge among Chinese Hospitalized Patients: A Prospective, Nationwide, Multicenter Study. J Am Coll Nutr 36:357–363. https://doi.org/10.1080/07315724.2017.1304293

    Article  PubMed  Google Scholar 

  11. Bousquet-Dion G, Awasthi R, Loiselle SÈ et al (2018) Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial. Acta Oncol 57:849–859. https://doi.org/10.1080/0284186X.2017.1423180

    Article  PubMed  Google Scholar 

  12. Chen BP, Awasthi R, Sweet SN et al (2017) Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Support Care Cancer 25:33–40. https://doi.org/10.1007/s00520-016-3379-8

    Article  PubMed  Google Scholar 

  13. Gillis C, Li C, Lee L et al (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121:937–947. https://doi.org/10.1097/aln.0000000000000393

    Article  PubMed  Google Scholar 

  14. Li C, Carli F, Lee L et al (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27:1072–1082. https://doi.org/10.1007/s00464-012-2560-5

    Article  PubMed  Google Scholar 

  15. Minnella EM, Bousquet-Dion G, Awasthi R et al (2017) Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol 56:295–300. https://doi.org/10.1080/0284186x.2016.1268268

    Article  PubMed  Google Scholar 

  16. Fulop A, Lakatos L, Susztak N et al (2020) The effect of trimodal prehabilitation on the physical and psychological health of patients undergoing colorectal surgery: a randomised clinical trial. Anaesthesia 76:82–90. https://doi.org/10.1111/anae.15215

    Article  PubMed  Google Scholar 

  17. Wang B, Shelat VG, Chow JJL et al (2020) Prehabilitation Program Improves Outcomes of Patients Undergoing Elective Liver Resection. J Surg Res 251:119–125. https://doi.org/10.1016/j.jss.2020.01.009

    Article  PubMed  Google Scholar 

  18. Bruns ER, van den Heuvel B, Buskens CJ et al (2016) The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis 18:O267-277. https://doi.org/10.1111/codi.13429

    Article  CAS  PubMed  Google Scholar 

  19. Lyons N, Bernardi K, Olavarria O et al (2020) Prehabilitation among Patients Undergoing Non-Bariatric Abdominal Surgery: A Systematic Review. J Am Coll Surg 231:480–489. https://doi.org/10.1016/j.jamcollsurg.2020.06.024

    Article  PubMed  Google Scholar 

  20. Vasta S, Papalia R, Torre G et al (2020) The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review. J Clin Med 9:969. https://doi.org/10.3390/jcm9040969

    Article  PubMed Central  Google Scholar 

  21. Forbes C, Swan F, Greenley S et al (2020) Physical activity and nutrition interventions for older adults with cancer: a systematic review. J Cancer Surviv 14:689–711. https://doi.org/10.1007/s11764-020-00883-x

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gillis C, Buhler K, Bresee L et al (2018) Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology 155:391-410.e394. https://doi.org/10.1053/j.gastro.2018.05.012

    Article  PubMed  Google Scholar 

  23. Looijaard S, Slee-Valentijn MS, Otten RHJ et al (2018) Physical and Nutritional Prehabilitation in Older Patients With Colorectal Carcinoma: A Systematic Review. J Geriatr Phys Ther 41:236–244. https://doi.org/10.1519/jpt.0000000000000125

    Article  PubMed  Google Scholar 

  24. Chia CL, Mantoo SK, Tan KY (2016) “Start to finish trans-institutional transdisciplinary care”: a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis 18:O43-50. https://doi.org/10.1111/codi.13166

    Article  CAS  PubMed  Google Scholar 

  25. Carli F, Bousquet-Dion G, Awasthi R et al (2020) Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer: A Randomized Clinical Trial. JAMA Surg 155:233–242. https://doi.org/10.1001/jamasurg.2019.5474

    Article  PubMed  PubMed Central  Google Scholar 

  26. van der Vlies E, Smits AB, Los M et al (2020) Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: Influence on patient selection, prehabilitation and outcome. J Geriatr Oncol 11:1237–1243. https://doi.org/10.1016/j.jgo.2020.04.011

    Article  PubMed  Google Scholar 

  27. van Rooijen SJ, Molenaar CJL, Schep G et al. (2019) Making patients fit for surgery: Introducing a four pillar multimodal prehabilitation program in colorectal cancer. Am J Phys Med Rehabil 98:888–896. https://doi.org/10.1097/PHM.0000000000001221

    Article  PubMed  Google Scholar 

  28. Bradley A, Marshall A, Stonehewer L et al (2013) Pulmonary rehabilitation programme for patients undergoing curative lung cancer surgery. Eur J Cardiothorac Surg 44:e266–e271. https://doi.org/10.1093/ejcts/ezt381

    Article  PubMed  Google Scholar 

  29. Wan X, Wang W, Liu J et al (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135. https://doi.org/10.1186/1471-2288-14-135

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pecorelli N, Fiore JF, Gillis C Jr et al (2016) The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties. Surg Endosc 30:2199–2206. https://doi.org/10.1007/s00464-015-4478-1

    Article  PubMed  Google Scholar 

  31. Luther A, Gabriel J, Watson R et al (2018) The Impact of Total body prehabilitation on post-operative outcomes after major abdominal surgery: a systematic review. World J Surg 42:2781–2791. https://doi.org/10.1007/s00268-018-4569-y

    Article  PubMed  Google Scholar 

  32. Hughes MJ, Hackney RJ, Lamb PJ et al (2019) Prehabilitation before major abdominal surgery: a systematic review and meta-analysis. World J Surg 43:1661–1668. https://doi.org/10.1007/s00268-019-04950-y

    Article  PubMed  Google Scholar 

  33. Chou Y, Kuo H, Shun S (2018) Cancer prehabilitation programs and their effects on quality of life. Oncol Nurs Forum 45:726–736. https://doi.org/10.1188/18.Onf.726-736

    Article  PubMed  Google Scholar 

  34. Daniels SL, Lee MJ, George J et al (2020) Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis. BJS Open. https://doi.org/10.1002/bjs5.50347,10.1002/bjs5.50347

    Article  PubMed  PubMed Central  Google Scholar 

  35. Mouch CA, Kenney BC, Lorch S et al (2020) Statewide prehabilitation program and episode payment in medicare beneficiaries. J Am Coll Surg 230:306–313. https://doi.org/10.1016/j.jamcollsurg.2019.10.014

    Article  PubMed  Google Scholar 

  36. Klainin-Yobas P, Oo WN, Suzanne Yew PY et al (2015) Effects of relaxation interventions on depression and anxiety among older adults: a systematic review. Aging Ment Health 19:1043–1055. https://doi.org/10.1080/13607863.2014.997191

    Article  PubMed  Google Scholar 

  37. Tew GA, Ayyash R, Durrand J et al (2018) Clinical guideline and recommendations on pre-operative exercise training in patients awaiting major non-cardiac surgery. Anaesthesia 73:750–768. https://doi.org/10.1111/anae.14177

    Article  CAS  PubMed  Google Scholar 

  38. Zhu M, Cui H, Chen W et al (2020) Guidelines for parenteral and enteral nutrition in geriatric patients in China. AGING MEDICINE 3:110–124. https://doi.org/10.1002/agm2.12110

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bolshinsky V, Li M, Ismail H et al (2018) Multimodal prehabilitation programs as a bundle of care in gastrointestinal cancer surgery: a systematic review. Dis Colon Rectum 61:124–138. https://doi.org/10.1097/dcr.0000000000000987

    Article  PubMed  Google Scholar 

  40. Faithfull S, Turner L, Poole K et al (2019) Prehabilitation for adults diagnosed with cancer: A systematic review of long-term physical function, nutrition and patient-reported outcomes. Eur J Cancer Care 28:e13023. https://doi.org/10.1111/ecc.13023

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China

    Chengyu Liu, Zhenhua Lu & Mingwei Zhu

  2. School of Psychology and Cognitive Science, Peking University, Beijing, 100871, People’s Republic of China

    Xinlian Lu

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  1. Chengyu Liu
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  4. Xinlian Lu
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Contributions

LCY and LZH performed data acquisition and screening. LCY and LXL participated in data analysis. LCY and ZMW were responsible for the concept and designed the study. LCY, LZH, LXL and ZMW discussed rational and revised the manuscript. ZMW made final approval of the version to be published. All the authors discussed the results and made devotion to the manuscript.

Corresponding author

Correspondence to Mingwei Zhu.

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All analyses were based on previous published studies, thus no ethical approval and patient consent are required.

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Liu, C., Lu, Z., Zhu, M. et al. Trimodal prehabilitation for older surgical patients: a systematic review and meta-analysis. Aging Clin Exp Res 34, 485–494 (2022). https://doi.org/10.1007/s40520-021-01929-5

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  • DOI: https://doi.org/10.1007/s40520-021-01929-5

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