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The Role and Effect of Multimodal Prehabilitation Before Major Abdominal Surgery: A Systemic Review and Meta-Analysis

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Abstract

Background

For patients undergoing abdominal surgery, multimodal prehabilitation, including nutrition and exercise interventions, aims to optimize their preoperative physical and physiological capacity. This meta-analysis aims to explore the impact of multimodal prehabilitation on surgical and functional outcomes of abdominal surgery.

Methods

Medline, Embase and CENTRAL were searched for articles about multimodal prehabilitation in major abdominal surgery. Primary outcomes were postoperative complications with a Clavien–Dindo score ≥3, and functional outcomes, measured by the 6-Minute Walking Test (6MWT). Secondary outcome measures included the quality-of-life measures. Pooled risk ratio (RR) and 95% confidence interval (CI) were estimated, with DerSimonian and Laird random effects used to account for heterogeneity.

Results

Twenty-five studies were included, analysing 4,210 patients across 13 trials and 12 observational studies. Patients undergoing prehabilitation had significantly fewer overall complications (RR = 0.879, 95% CI 0.781–0.989, p = 0.034). There were no significant differences in the rates of wound infection, anastomotic leak and duration of hospitalization. The 6MWT improved preoperatively in patients undergoing prehabilitation (SMD = 33.174, 95% CI 12.674–53.673, p = 0.005), but there were no significant differences in the 6MWT at 4 weeks (SMD = 30.342, 95% CI − 2.707–63.391, p = 0.066) and 8 weeks (SMD = 24.563, 95% CI − 6.77–55.900, p = 0.104) postoperatively.

Conclusions

As preoperative patient optimization shifts towards an interdisciplinary approach, evidence from this meta-analysis shows that multimodal prehabilitation improves the preoperative functional capacity and reduces postoperative complication rates, suggesting its potential in effectively optimizing the abdominal surgery patient. However, there is a large degree of heterogenicity between the prehabilitation interventions between included articles; hence results should be interpreted with caution.

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Acknowledgements

We would like to thank Ms Annelissa Chin from Yong Loo Lin School of Medicine, Medical Library, for advising us with the search strategy for this meta-analysis.

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  1. Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore

    Sneha Rajiv Jain, Vasundhara Lakshmi Kandarpa & Clyve Yu Leon Yaow

  2. Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore

    Winson JianHong Tan, Leonard Ming Li Ho, Sharmini Su Sivarajah, Jia Lin Ng, Cheryl Xi Zi Chong, Darius Kang Lie Aw, Fung Joon Foo & Frederick Hong Xiang Koh

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Jain, S.R., Kandarpa, V.L., Yaow, C.Y.L. et al. The Role and Effect of Multimodal Prehabilitation Before Major Abdominal Surgery: A Systemic Review and Meta-Analysis. World J Surg 47, 86–102 (2023). https://doi.org/10.1007/s00268-022-06761-0

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