Prehabilitation Before Abdominal Surgery: A Systematic Review of the Literature and Meta-Analysis

Author(s):
Karla Bernardi; Oscar A. Olavarria; Julie Holihan; Nicole Lyons; Alexis Milton; Deepa Cherla; Tien Ko; Lillian Kao; Mike Liang

Background:

Patients who are obese or have poor fitness are at increased risk for complications, such as surgical site infections (SSI), following abdominal surgery. For this reason, there has been substantial interest in the role of prehabilitation, or preoperative exercise and nutritional counseling, in reducing surgical complications.

Hypothesis:

We hypothesized that prehabilitation prior to abdominal surgery is associated with a decreased rate of SSIs among patients undergoing abdominal surgery.

Methods:

A Systematic Review of the literature was performed using PubMed, Embase, and Cochrane Library following the PRISMA guidelines. Two independent reviewers identified randomized controlled trials (RCTs) regarding prehabilitation with an exercise regimen and/or nutritional counseling prior to non-bariatric abdominal surgery compared to usual care. Only manuscripts reporting their rate of SSIs were included. Cumulative analysis was performed with Fishers exact test.  Meta-analysis was performed using a fixed effects model and heterogeneity was assessed using Higgins I-square.

Results:

A total of 153 titles were screened to identify a potential of 27 manuscripts. After review, four RCTs evaluating 340 patients met criteria to be included for analysis.  Prehabilitation was associated with improvements in fitness and weight loss in all studies. There were no difference in SSI when comparing prehabilitation and usual care on both cumulative analysis (5.5% vs 5.0%, p=1.00) and meta-analysis (relative risk = 1.00; 95% confidence interval = 0.95-1.05, I-square=0.0%) (Figure).

Conclusions:

Surprisingly, prehabilitation is not associated with a decreased rate of SSIs in patients undergoing non-bariatric abdominal surgery. While substantial interest exists in prehabilitation and its potential benefits, the value of these programs remains unclear.  Future studies should assess a composite prehabilition regimen, which include risk reduction strategies for SSI including smoking cessation and glycemic control.