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A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366)

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Physical exercise prehabilitation has been proposed to improve postoperative outcomes in patients undergoing major abdominal surgery. The aim of this systematic review was to investigate the effect of preoperative exercise training compared with standard care on postoperative outcomes in major abdominal surgery.

Methods

Randomized controlled trials (RCT) comparing prehabilitation with standard care were identified by a systematic literature search of MEDLINE and CENTRAL. Qualitative and quantitative analyses of perioperative outcome data were conducted. Meta-analyses were performed wherever possible and meaningful.

Results

A total of eight trials including 442 patients met the inclusion criteria. These trials investigated the effect of prehabilitation in patient cohorts undergoing major liver, colorectal, gastroesophageal, and general abdominal surgery. Quantitative analyses of all included trials showed a significant reduction in postoperative pulmonary complications (OR 0.37; 0.20 to 0.67; p = 0.001) as well as in postoperative overall morbidity (OR 0.52; 0.30 to 0.88; p = 0.01) in the prehabilitation group compared with standard care. The length of hospital stay showed no significant differences between the groups (MD − 0.58; − 1.28 to 0.13; p = 0.11). Risk of bias and methodological quality varied substantially among the trials, most of which were small single-center studies.

Conclusion

Prehabilitation including a physical exercise intervention may lead to a reduction of postoperative pulmonary complications as well as less overall morbidity compared with standard care in patients undergoing major abdominal surgery. Further, well-designed RCT are needed to evaluate these potential positive effects in more detail and to identify suitable target populations.

Protocol Registration

PROSPERO 2017 CRD42017080366

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Funding

The resources and facilities of the University of Heidelberg were used in conducting this study. No additional funding was applied for or received.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Patrick Heger, Pascal Probst, Markus K. Diener & André L. Mihaljevic

  2. The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Patrick Heger, Pascal Probst, Markus K. Diener & André L. Mihaljevic

  3. National Center of Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany

    Joachim Wiskemann & Karen Steindorf

  4. German Cancer Research Center (DKFZ), Division of Physical Activity, Prevention and Cancer, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Karen Steindorf

Authors
  1. Patrick Heger
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  6. André L. Mihaljevic
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Contributions

PH and ALM developed the study concept. MKD, PP, JW, and KS helped to develop the study concept and gave methodological advice. PH and ALM carried out the literature search and data extraction. PH and ALM conducted statistical analyses. PH and ALM wrote the first draft of the manuscript. MKD, PP, JW, and KS provided scientific input for the study’s background and rationale and contributed to interpretation of the data. All authors read, critically revised, and approved the final manuscript.

Corresponding author

Correspondence to André L. Mihaljevic.

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: Example of a search strategy for MEDLINE (via PubMed). (DOCX 12 kb)

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Heger, P., Probst, P., Wiskemann, J. et al. A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg 24, 1375–1385 (2020). https://doi.org/10.1007/s11605-019-04287-w

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  • DOI: https://doi.org/10.1007/s11605-019-04287-w

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