title: Pre-admission interventions to improve outcome after elective surgery-protocol for a systematic review.
abstract: BACKGROUND
  Poor physical health and fitness increases the risk of death and complications after major elective surgery. Pre-admission interventions to improve patients' health and fitness (referred to as prehabilitation) may reduce postoperative complications, decrease the length of hospital stay and facilitate the patient's recovery. We will conduct a systematic review of RCTs to examine the effectiveness of different types of prehabilitation interventions in improving the surgical outcomes of patients undergoing elective surgery.
  
  
  METHODS
  This review will be conducted and reported according to the Cochrane and PRISMA reporting guidelines. MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, ISI Web of Science and clinical trial registers will be searched for any intervention administered before any elective surgery (including physical activity, nutritional, educational, psychological, clinical or multicomponent), which aims to improve postoperative outcomes. Reference lists of included studies will be searched, and grey literature including conference proceedings, theses, dissertations and preoperative assessment protocols will be examined. Study quality will be assessed using Cochrane's risk of bias tool, and meta-analyses for trials that use similar interventions and report similar outcomes will be undertaken where possible.
  
  
  CONCLUSIONS
  This systematic review will determine whether different types of interventions administered before elective surgery are effective in improving postoperative outcomes. It will also determine which components or combinations of components would form the most effective prehabilitation intervention.
  
  
  BACKGROUND
  PROSPERO CRD42015019191.
authors.affiliation: Biomedical Research Unit in Nutrition Diet and Lifestyle, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Perry
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Scott
authors.affiliation: NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Richards
authors.affiliation: Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, 8 Priory Road, Bristol, BS8 1TZ, UK.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Haase
authors.affiliation: NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.
authors.forename: Jelena
authors.initials: J
authors.lastname: Savović
authors.affiliation: Biomedical Research Unit in Nutrition Diet and Lifestyle, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Ness
authors.affiliation: Biomedical Research Unit in Nutrition Diet and Lifestyle, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Atkinson
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Harris
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Culliford
authors.affiliation: Preoperative Assessment Clinic, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK.
authors.forename: Sanjoy
authors.initials: S
authors.lastname: Shah
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol, BS2 8HW, UK. Maria.Pufulete@bristol.ac.uk.
authors.forename: Maria
authors.initials: M
authors.lastname: Pufulete
mesh_terms: D017558:Elective Surgical Procedures; D015444:Exercise; D006801:Humans; D007902:Length of Stay; D018529:Nutritional Support; D010353:Patient Education as Topic; D010809:Physical Fitness; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D000078202:Systematic Reviews as Topic
keywords: Elective surgery; Improving fitness before surgery; Physical activity; Prehabilitation; Preoperative nutrition; Systematic review