Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials.
Level 1 - systematic review of randomized trials
Systematic review with network meta-analysis of randomized controlled trials
PubMed 39843215 · doi:10.1136/bmj-2024-081164
What was done
Authors conducted a systematic review, random-effects network meta-analysis, and component network meta-analysis of randomized controlled trials across six databases through October 2023. They assessed adults preparing for major surgery randomized to prehabilitation interventions (exercise, nutritional, cognitive, and psychosocial components, alone or in combination) versus usual care. Measured outcomes included postoperative complications, length of stay, health-related quality of life (SF-36 physical component scale), and physical recovery (six-minute walk test). Certainty was graded using the Confidence in Network Meta-Analysis (CINeMA) framework.
What was found
Across 186 RCTs (15,684 participants), isolated exercise (OR 0.50, 95% CI 0.39 to 0.64; very low certainty), isolated nutrition (OR 0.62, 95% CI 0.50 to 0.77; very low certainty), and combined exercise, nutrition, and psychosocial prehabilitation (OR 0.64, 95% CI 0.45 to 0.92; very low certainty) reduced complications versus usual care. Reductions in length of stay were observed for combined exercise and psychosocial prehabilitation (-2.44 days, 95% CI -3.85 to -1.04; very low certainty), combined exercise and nutrition (-1.22 days, 95% CI -2.54 to 0.10; moderate certainty), isolated exercise (-0.93 days, 95% CI -1.27 to -0.58; very low certainty), and isolated nutrition (-0.99 days, 95% CI -1.49 to -0.48; very low certainty). Combined exercise, nutrition, plus psychosocial prehabilitation improved SF-36 physical score (mean difference 3.48, 95% CI 0.82 to 6.14; very low certainty) and six-minute walk distance (mean difference 43.43 meters, 95% CI 5.96 to 80.91; very low certainty). Component network meta-analysis identified exercise and nutrition as the main individual components improving all critical outcomes.
Why it matters
This review disentangles multi-modal prehabilitation packages, identifying exercise and nutrition as the primary active drivers for reducing surgical complications and hospital stay length.
Limits
Evidence certainty was low to very low across most comparisons due to risk of bias in the included trials and imprecision. The abstract provides no granular breakdown by specific surgical sub-specialties or intervention adherence rates.
Cited by
- supports In the general surgical literature, prehabilitation exercise programs prior to major surgery reduce surgical complications and shorten hospital length of stay.