Preoperative exercise therapy for elective major abdominal surgery: a systematic review

Area of Science:

• Surgical Outcomes
• Rehabilitation Medicine
• Pulmonary Physiology

Background:

• Major abdominal surgery (MAS) carries substantial risks of postoperative complications.
• Socio-economic factors amplify the impact of these complications.
• Preoperative interventions are crucial for optimizing patient outcomes.

Purpose of the Study:

• To systematically review the effects of preoperative exercise therapy (PEXT) on physical fitness before MAS.
• To evaluate PEXT's impact on hospital admission length and postoperative complications.
• To identify effective exercise regimes for patients undergoing MAS.

Main Methods:

• Systematic search of randomized controlled trials on exercise therapy and pulmonary physiotherapy before MAS.
• Methodological quality assessment using the 'Delphi List For Quality Assessment of Randomised Clinical Trials'.
• Inter-rater reliability assessed with Cohen's kappa (kappa=0.90).

Main Results:

• Six studies of moderate to good quality were included.
• PEXT improved physical fitness in three studies.
• Two studies showed contradictory results regarding PEXT's effect on postoperative complications.
• Preoperative chest physiotherapy showed positive effects on lung function, but optimal regimes remain unclear.

Conclusions:

• PEXT may improve physical fitness in patients scheduled for MAS.
• Preoperative chest physiotherapy appears effective in reducing pulmonary complications.
• Further research is needed to determine optimal PEXT methods and effects, especially for high-risk procedures.