Background Preoperative physical fitness is predictive of postoperative outcome. Patients with lesser aerobic capacity are at greater risk of postoperative complications, longer hospital stays, and ...mortality. Prehabilitation may improve physical fitness, but it is unknown whether enhanced fitness translates to an improvement in postoperative outcome. Methods This systematic review and meta-analysis aimed to assess the ability of prehabilitation to influence postoperative outcome after intra-abdominal operations. Randomized controlled trials with at least 1 group undergoing a preoperative exercise intervention/prehabilitation were included. The following databases were searched: AMED, CINAHL, EMBASE, PubMed/Medline, and The Cochrane Library. Data extracted from 9 full-articles included author(s), population demographics, type of operation, postoperative measures of outcome, and type of treatment of the prehabilitation and control groups. Methodologic quality was assessed using GRADEpro, and the Cochrane risk of bias tool was used to measure study bias. Results Prehabilitation consisting of inspiratory muscle training, aerobic exercise, and/or resistance training can decrease all types of postoperative complications after intra-abdominal operations (odds ratio: 0.59, 95% confidence interval: 0.38–0.91, P = .03). It is unclear from our meta-analysis whether prehabilitation can decrease postoperative length of stay, because the number of studies that examined length of stay was small ( n = 4). No postoperative mortality was reported in any study, and conclusions could not be drawn on the ability of exercise to influence operative mortality. The methodologic quality of studies was, however, “very low.” Conclusion Prehabilitation appears to be beneficial in decreasing the incidence of postoperative complications; however, more high-quality studies are needed to validate its use in the preoperative setting.
Abstract Study objective To assess the ability of field tests of exercise tolerance, such as the 6-minute walk test (6MWT) and incremental shuttle walk test (ISWT), to predict postoperative outcome ...following intra-abdominal surgery. Design A systematic review. Setting A hospital-affiliated university. Measurements The following databases were searched: AMED, CINAHL, EMBASE, PEDro, PubMed/MEDLINE, and The Cochrane Library. Six full-text articles were included. Data extraction included author, population demographics, surgery type, postoperative outcome measure, and field test results. The risk of bias was performed using the Quality in Prognosis Studies tool. Results Surgical procedures reviewed were colorectal (n = 3), upper gastrointestinal (n = 1), and intra-abdominal surgery (n = 2). Field tests of exercise tolerance showed little ability to predict postoperative mortality; however, the overall rate of mortality was low. Patients achieving lower distances on the ISWT tended to have longer hospital stays and an increased risk of overall complications. The 6MWT does not appear able to predict postoperative cardiac or pulmonary complications; however, it may be suitable to predict general complications. Conclusions Field tests may be able to predict postoperative outcome; however, further validation is needed. The ISWT appears to be the superior field test. The 6MWT and stair climb test require further validation to assess their predictive ability.
