PREHABILITATION AND POSTOPERATIVE BURDEN OF HIGH-RISK CANCER PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Abstract
Introduction. Prehabilitation aims to optimize patients before surgical treatment in order to improve postsurgical recovery. While its efficacy to improve major postoperative clinical outcomes have been recognized for the broader low-risk surgical population, it remains unclear if the high-risk surgical population also benefits. This meta-analysis assessed the impact of prehabilitation on postoperative outcomes in high-risk surgical cancer patients
Methodology: We searched for experimental (randomized and non- randomized) and observational studies investigating the impact of prehabilitation in the frequency and/or severity (e.g minor and major complications) of post-surgical complications (primary outcome), type of complications, functional capacity, hospital readmissions, length of hospital stay and 30 day post-surgical mortality (secondary outcomes). High-risk patients for adverse surgical events were defined as frail and / or age ≥70 years and / or with an ASA score of >III.
Results: 136 articles were found, of which only 6 were eligible for qualitative and quantitative evaluation (3 randomized and 3 observational studies). The analysis resulted in a total of 674 participants, with an average age of 78 years, mostly male. Prehabilitation resulted in a lower risk of major complications (risk difference –0.09, 95% CI: –0.15, – 0.03, p = 0.005; i2 = 27%, p = 0.24) and surgical complications (RR 0.62, 95% CI 0.43 to 0.89, p=0.01; I2 = 33%, p = 0.22) in comparison to patients receiving standard care. Also, prehabilitation reduced the length of hospital stay (mean difference of – 2.7, 95% CI: –5.37 to –0.17, p = 0.04) and improved functional recovery as assessed by the distance covered in the 6 MWT (mean difference 29.06 meters, 95% CI 26.55 to 31.57, I2 = 42%, p < 0.001). No differences were observed for the rate of overall complications, medical complications 30-day postoperative mortality or hospital readmission.
Conclusion: Our work suggests that prehabilitation is effective in reducing postoperative burden in high-risk cancer patients. Future randomized controlled trials for the high-risk surgical patients, using well-established and clinically relevant outcome measures, and with appropriate sample size calculation are needed.
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References
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