Prehabilitation before surgery: Is it for all patients?

Malcolm A West; Sandy Jack; Michael P W Grocott

doi:10.1016/j.bpa.2021.01.001

Prehabilitation before surgery: Is it for all patients?

Best Pract Res Clin Anaesthesiol. 2021 Dec;35(4):507-516. doi: 10.1016/j.bpa.2021.01.001. Epub 2021 Jan 27.

Authors

Malcolm A West¹, Sandy Jack², Michael P W Grocott³

Affiliations

¹ School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Biomedical Research Centre, Southampton, University Hospital Southampton NHS Foundation Trust, UK; Anaesthesia, Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK; Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
² University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Biomedical Research Centre, Southampton, University Hospital Southampton NHS Foundation Trust, UK; Anaesthesia, Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK; Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
³ University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Biomedical Research Centre, Southampton, University Hospital Southampton NHS Foundation Trust, UK; Anaesthesia, Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK; Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA. Electronic address: mike.grocott@soton.ac.uk.

PMID: 34801213
DOI: 10.1016/j.bpa.2021.01.001

Abstract

Purpose: To evaluate the role of prehabilitation interventions in adult patients before elective major surgery.

Recent findings: Exercise training before elective adult major surgery is feasible and safe. Efficacy has been determined but the clinical effectiveness remains uncertain. Early data suggest a reduction in morbidity, length of stay, and an improvement in the quality of life. Nutritional and psychological interventions are less well evaluated, and when they are, it is often in combination with exercise interventions as part of multimodal prehabilitation.

Summary: Studies evaluating multimodal prehabilitation interventions before elective major surgery in adults are producing encouraging early results, but definitive clinical effectiveness is currently very limited. Future research should focus on refining interventions, exploring mechanisms, establishing minimum dosage, interrogating interactions between therapies, and urgent implementation of large-scale clinical effectiveness studies.

Keywords: exercise; mortality; multimodal prehabilitation; nutrition; postoperative outcome; stress of surgery.

Publication types

Review

MeSH terms

Adult
Elective Surgical Procedures
Humans
Postoperative Complications / prevention & control
Preoperative Care
Preoperative Exercise*
Quality of Life*
Treatment Outcome