Towards a common definition of surgical prehabilitation: a scoping review of randomised trials

Chloé Fleurent-Grégoire; Nicola Burgess; Daniel I McIsaac; Stéphanie Chevalier; Julio F Fiore Jr; Francesco Carli; Denny Levett; John Moore; Michael P Grocott; Robert Copeland; Lara Edbrooke; Dominique Engel; Giuseppe Dario Testa; Linda Denehy; Chelsia Gillis

doi:10.1016/j.bja.2024.02.035

Towards a common definition of surgical prehabilitation: a scoping review of randomised trials

Br J Anaesth. 2024 Apr 26:S0007-0912(24)00182-X. doi: 10.1016/j.bja.2024.02.035. Online ahead of print.

Authors

Affiliations

¹ School of Human Nutrition, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Montréal, QC, Canada.
² Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia.
³ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁴ School of Human Nutrition, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Montréal, QC, Canada; Department of Medicine, McGill University, Montréal, QC, Canada.
⁵ Department of Surgery, McGill University, Montréal, QC, Canada.
⁶ Department of Anesthesia, McGill University, Montréal, QC, Canada.
⁷ Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK.
⁸ Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK.
⁹ Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield UK.
¹⁰ Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
¹¹ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
¹² Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
¹³ Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. Electronic address: l.denehy@unimelb.edu.au.
¹⁴ School of Human Nutrition, McGill University, Montréal, QC, Canada; Department of Surgery, McGill University, Montréal, QC, Canada; Department of Anesthesia, McGill University, Montréal, QC, Canada. Electronic address: chelsia.gillis@mcgill.ca.

PMID: 38677949
DOI: 10.1016/j.bja.2024.02.035

Abstract

Background: There is no universally accepted definition for surgical prehabilitation. The objectives of this scoping review were to (1) identify how surgical prehabilitation is defined across randomised controlled trials and (2) propose a common definition.

Methods: The final search was conducted in February 2023 using MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane. We included randomised controlled trials (RCTs) of unimodal or multimodal prehabilitation interventions (nutrition, exercise, and psychological support) lasting at least 7 days in adults undergoing elective surgery. Qualitative data were analysed using summative content analysis.

Results: We identified 76 prehabilitation trials of patients undergoing abdominal (n=26, 34%), orthopaedic (n=20, 26%), thoracic (n=14, 18%), cardiac (n=7, 9%), spinal (n=4, 5%), and other (n=5, 7%) surgeries. Surgical prehabilitation was explicitly defined in more than half of these RCTs (n=42, 55%). Our findings consolidated the following definition: 'Prehabilitation is a process from diagnosis to surgery, consisting of one or more preoperative interventions of exercise, nutrition, psychological strategies and respiratory training, that aims to enhance functional capacity and physiological reserve to allow patients to withstand surgical stressors, improve postoperative outcomes, and facilitate recovery.'

Conclusions: A common definition is the first step towards standardisation, which is needed to guide future high-quality research and advance the field of prehabilitation. The proposed definition should be further evaluated by international stakeholders to ensure that it is comprehensive and globally accepted.

Keywords: Enhanced Recovery After Surgery; pre-rehabilitation; pre-surgery; prehabilitation; preoperative.

Publication types

Review