Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews

Daniel I McIsaac; Marlyn Gill; Laura Boland; Brian Hutton; Karina Branje; Julia Shaw; Alexa L Grudzinski; Natasha Barone; Chelsia Gillis; Prehabilitation Knowledge Network

doi:10.1016/j.bja.2021.11.014

Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews

Br J Anaesth. 2022 Feb;128(2):244-257. doi: 10.1016/j.bja.2021.11.014. Epub 2021 Dec 16.

Authors

Daniel I McIsaac¹, Marlyn Gill², Laura Boland³, Brian Hutton⁴, Karina Branje⁵, Julia Shaw⁵, Alexa L Grudzinski⁶, Natasha Barone⁷, Chelsia Gillis⁸; Prehabilitation Knowledge Network

Collaborators

Prehabilitation Knowledge Network:
Shamsuddin Akhtar⁹, Marlis Atkins¹⁰, Sylvie Aucoin¹¹, Rebecca Auer¹², Carlota Basualdo-Hammond¹³, Paul Beaule¹⁴, Mary Brindle¹⁵, Honorata Bittner¹⁶, Gregory Bryson¹⁷, Franco Carli¹⁸, Antoine Eskander¹⁹, Paola Fata²⁰, Dean Fergusson²¹, Julio Fiore Jr²², Alan Forster²³, Melani Gillam²⁴, Leah Gramlich²⁵, Jayna Holroyd-Leduc²⁶, Timothy Jackson²⁷, Eric Jacobsohn²⁸, Rachel Khadaroo²⁹, Manoj Lalu³⁰, Cameron Love³¹, Guillaume Martel³², Colin McCartney³³, Dolores McKeen³⁴, Amanda Meliambro³⁵, Husein Moloo³⁶, Ronald Moore³⁷, John Muscedere³⁸, Julie Nantel³⁹, Stephane Poitras⁴⁰, Celena Scheede-Bergdahl⁴¹, Monica Taljaard⁴², Tom Wallace⁴³, Duminda Wijeysundera⁴⁴

Affiliations

¹ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. Electronic address: dmcisaac@toh.ca.
² Patient and Community Engagement Research Program, University of Calgary, Calgary, AB, Canada.
³ Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁴ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁵ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
⁷ Department of Medicine, McGill University, Montreal, QC, Canada.
⁸ Department of Anesthesia, McGill University, Montreal, QC, Canada.
⁹ Yale University, School of Medicine, New Haven, United States. Electronic address: shamsuddin.akhtar@yale.edu.
¹⁰ Alberta Health Services, Edmonton, Canada. Electronic address: marlis.atkins@ahs.ca.
¹¹ The Ottawa Hospital, Department of Anesthesiology and Pain Medicine, Ottawa, Canada. Electronic address: syaucoin@toh.ca.
¹² The Ottawa Hospital, Department of Surgery, Ottawa, Canada. Electronic address: rauer@toh.ca.
¹³ Alberta Health Services, Edmonton, Canada. Electronic address: carlota.basualdo@ahs.ca.
¹⁴ University of Ottawa, Department of Surgery, Ottawa, Canada. Electronic address: pbeaule@toh.ca.
¹⁵ The University of Calgary, Calgary, Canada. Electronic address: mmbrindl@ucalgary.ca.
¹⁶ The Ottawa Hospital, Ottawa, Canada. Electronic address: hbittner@toh.ca.
¹⁷ The Ottawa Hospital, Department of Anesthesiology and Pain Medicine, Ottawa, Canada. Electronic address: glbryson@toh.ca.
¹⁸ McGill University, Department of Anesthesiology, Montreal, Canada. Electronic address: franco.carli@mcgill.ca.
¹⁹ Sunnybrook Hospital, Toronto, Canada. Electronic address: Antoine.Eskander@sunnybrook.ca.
²⁰ McGill University, Division of General Surgery, Montreal, Canada. Electronic address: paola.fata@mcgill.ca.
²¹ Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada. Electronic address: dafergusson@ohri.ca.
²² McGill University, Division of General Surgery, Montreal, Canada. Electronic address: julio.fiorejunior@mcgill.ca.
²³ Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada. Electronic address: aforster@toh.ca.
²⁴ Alberta Health Services, Edmonton, Canada. Electronic address: Melani.Gillam@albertahealthservices.ca.
²⁵ University of Alberta, Edmonton, Canada. Electronic address: lg3@ualberta.ca.
²⁶ Alberta Health Services, Edmonton, Canada. Electronic address: Jayna.Holroyd-Leduc@albertahealthservices.ca.
²⁷ University Health Network, Toronto, Canada. Electronic address: timothy.jackson@uhn.ca.
²⁸ University of Manitoba, Faculty of Medicine, Winnipeg, Canada. Electronic address: EJacobsohn@hsc.mb.ca.
²⁹ University of Alberta, Department of Surgery, Edmonton, Canada. Electronic address: khadaroo@ualberta.ca.
³⁰ Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada. Electronic address: mlalu@toh.ca.
³¹ The Ottawa Hospital, Ottawa, Canada. Electronic address: clove@toh.ca.
³² Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada. Electronic address: gumartel@toh.ca.
³³ The Ottawa Hospital, Department of Anesthesiology and Pain Medicine, Ottawa, Canada. Electronic address: cmccartney@toh.ca.
³⁴ Memorial University of Newfoundland, St. John's, Canada. Electronic address: dmckeen@mun.ca.
³⁵ Carleton University, Ottawa, Canada. Electronic address: AmandaMeliambro@cmail.carleton.ca.
³⁶ The Ottawa Hospital, Department of Surgery, Ottawa, Canada. Electronic address: hmoloo@toh.ca.
³⁷ Alberta Health Services, Edmonton, Canada. Electronic address: Ron.Moore@albertahealthservices.ca.
³⁸ Kingston General Hospital, Department of Critical Care, Kingston, Canada. Electronic address: john.muscedere@kingstonhsc.ca.
³⁹ University of Ottawa, Faculty of Health Sciences, Ottawa, Canada. Electronic address: jnantel@uottawa.ca.
⁴⁰ University of Ottawa, Faculty of Health Sciences, Ottawa, Canada. Electronic address: stephane.poitras@uottawa.ca.
⁴¹ Montreal General Hospital, Department of Anesthesiology, Montreal, Canada. Electronic address: celena.scheede@mcgill.ca.
⁴² Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada. Electronic address: mtaljaard@ohri.ca.
⁴³ University of British Columbia, Department of Surgery, Kamloops, Canada. Electronic address: tom.wallace@me.com.
⁴⁴ St. Michael's Hospital, Department of Anesthesia, Toronto, Canada. Electronic address: d.wijeysundera@utoronto.ca.

PMID: 34922735
DOI: 10.1016/j.bja.2021.11.014

Abstract

Background: The certainty that prehabilitation improves postoperative outcomes is not clear. The objective of this umbrella review (i.e. systematic review of systematic reviews) was to synthesise and evaluate evidence for prehabilitation in improving health, experience, or cost outcomes.

Methods: We performed an umbrella review of prehabilitation systematic reviews. MEDLINE, Embase, Cochrane, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Joanna Briggs Institute's database, and Web of Science were searched (inception to October 20, 2020). We included all systematic reviews of elective, adult patients undergoing surgery and exposed to a prehabilitation intervention, where health, experience, or cost outcomes were reported. Evidence certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation. Primary syntheses of any prehabilitation were stratified by surgery type.

Results: From 1412 titles, 55 systematic reviews were included. For patients with cancer undergoing surgery who participate in any prehabilitation, moderate certainty evidence supports improvements in functional recovery. Low to very low certainty evidence supports reductions in complications (mixed, cardiovascular, and cancer surgery), non-home discharge (orthopaedic surgery), and length of stay (mixed, cardiovascular, and cancer surgery). There was low to very low certainty evidence that exercise prehabilitation reduces the risk of complications, non-home discharge, and length of stay. There was low to very low certainty evidence that nutritional prehabilitation reduces risk of complications, mortality, and length of stay.

Conclusions: Low certainty evidence suggests that prehabilitation may improve postoperative outcomes. Future low risk of bias, randomised trials, synthesised using recommended standards, are required to inform practice. Optimal patient selection, intervention design, and intervention duration must also be determined.

Keywords: exercise; nutrition; patient partnership; postoperative outcomes; prehabilitation; surgery; systematic review; umbrella review.

Publication types

Systematic Review

MeSH terms

Adult
Elective Surgical Procedures / methods*
Humans
Length of Stay
Nutrition Therapy / methods
Patient Selection
Postoperative Complications / ethnology*
Preoperative Exercise*
Randomized Controlled Trials as Topic
Systematic Reviews as Topic