The impact of prehabilitation on outcomes in frail and high-risk patients undergoing major abdominal surgery: a systematic review and meta-analysis

Background & aims: Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes.The aim of this systematic review and meta-analysis was to determine the impact of prehabilitation on postoperative outcomes in frail and high-risk patients undergoing major abdominal surgery.Methods: Embase, Medline, CINAHAL and Cochrane databases were searched from January 2010 to January 2023 for randomised clinical trials (RCTs) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes.Meta-analysis was limited to length of stay (primary end point), severe postoperative complications (Clavien-Dindo Classification !Grade 3) and the 6minute walk test (6MWT).The analysis was performed using RevMan v5.4 software.Results: Sixteen studies (6 RCTs, 10 observational) reporting on 3339 patients (1468 prehabilitation group, 1871 control group) were included.The median (interquartile range) age was 74.0 (71.0 e78.4) years.Multimodal prehabilitation was applied in fifteen studies and unimodal in one.Metaanalysis of nine studies showed a reduction in hospital length of stay (weighted mean difference À1.07 days, 95 % CI À1.60 to À0.53 days, P < 0.0001, I 2 ¼ 19 %).Ten studies addressed severe complications and a meta-analysis suggested a decline in occurrence by up to 44 % (odds ratio 0.56, 95 % CI 0.37 to 0.82, P < 0.004, I 2 ¼ 51 %).Four studies provided data on preoperative 6MWT.The pooled weighted mean difference was 40.1 m (95 % CI 32.7 to 47.6 m, P < 0.00001, I 2 ¼ 24 %), favouring prehabilitation.