title: The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis.
abstract: 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.
  
  
  
  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.
  
  
  
  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."
  
  
  
  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.
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, Dublin, Ireland. Electronic address: moranj2@tcd.ie.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Moran
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, Dublin, Ireland.
authors.forename: Emer
authors.initials: E
authors.lastname: Guinan
authors.affiliation: Department of Colorectal Surgery, St. James's Hospital, Dublin, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: McCormick
authors.affiliation: Department of Colorectal Surgery, St. James's Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Larkin
authors.affiliation: John Strearne Medical Library, Trinity College Dublin, Trinity Centre for Health Sciences, Dublin, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Mockler
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, Dublin, Ireland.
authors.forename: Juliette
authors.initials: J
authors.lastname: Hussey
authors.affiliation: Department of Anaesthesia and Intensive Care, St. James's Hospital, Dublin, Ireland.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Moriarty
authors.affiliation: Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, Dublin, Ireland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Wilson
mesh_terms: D000005:Abdomen / Q000601:surgery; D002423:Cause of Death; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000401:mortality*; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008297:Male; D010809:Physical Fitness / Q000502:physiology*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome