Effects of prehabilitation on postoperative outcomes in frail cancer patients undergoing elective surgery: a systematic review and meta-analysis

Abstract

Purpose: This systematic review and meta-analys is aimed to explore the effects of prehabilitation on postoperative outcomes in frail cancer patients.

Methods: A comprehensive literature search was conducted using PubMed, Cochrane Library, Embase, Web of Science, CINAHL Complete, and other databases from database inception to 15 March 2022. Studies were included if they consisted of a prehabilitation intervention in frail cancer patients undergoing elective surgery.

Results: A total of 9 studies encompassing 1313 patients were included in the review. Through meta-analysis, prehabilitation has a positive impact on total complications (RR = 0.83, 95% CI = 0.73 to 0.94, P = 0.004), severe complications (RR = 0.62, 95% CI = 0.43 to 0.90, P = 0.01), and the average length of hospital stay (MD = - 1.36, 95% CI = - 2.38 to - 0.35, P = 0.008). But it had no differences in 30-day and 3-month mortality and 30-day and 3-month readmission rates. Through qualitative synthesis, two studies found that prehabilitation had a favorable tendency to promote functional recovery compared with the control group.

Conclusion: Prehabilitation had a positive effect on postoperative complications and the average length of hospital stay in frail cancer patients. A personalized and supervised multimodal prehabilitation program with exercise at its core may be more beneficial for them. More studies with extensive follow-up are needed to confirm and update the findings of these results.

Keywords: Cancer; Frailty; Postoperative outcomes; Prehabilitation; Surgery.