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

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.

Authors+Show Affiliations

Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.National Center of Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.National Center of Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. German Cancer Research Center (DKFZ), Division of Physical Activity, Prevention and Cancer, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. andre.mihaljevic@med.uni-heidelberg.de. The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. andre.mihaljevic@med.uni-heidelberg.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31228083

Citation

Heger, Patrick, et al. "A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366)." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 2019.
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. 2019.
Heger, P., Probst, P., Wiskemann, J., Steindorf, K., Diener, M. K., & Mihaljevic, A. L. (2019). A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, doi:10.1007/s11605-019-04287-w.
Heger P, et al. A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg. 2019 Jun 21; PubMed PMID: 31228083.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). AU - Heger,Patrick, AU - Probst,Pascal, AU - Wiskemann,Joachim, AU - Steindorf,Karen, AU - Diener,Markus K, AU - Mihaljevic,André L, Y1 - 2019/06/21/ PY - 2019/02/06/received PY - 2019/05/26/accepted PY - 2019/6/23/entrez KW - Major abdominal surgery KW - Prehabilitation JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J. Gastrointest. Surg. N2 - 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. SN - 1873-4626 UR - https://www.unboundmedicine.com/medline/citation/31228083/A_Systematic_Review_and_Meta_analysis_of_Physical_Exercise_Prehabilitation_in_Major_Abdominal_Surgery__PROSPERO_2017_CRD42017080366__ L2 - https://linkinghub.elsevier.com/retrieve/pii/10.1007/s11605-019-04287-w DB - PRIME DP - Unbound Medicine ER -