Introduction Enhanced recovery after surgery (ERAS) involves preoperative optimisation in order to reduce surgical stress response. However, extended preoperative prehabilitation programmes are gaining popularity, particularly in patients with reduced functional capacity. The actual impact of prehabilitation programmes within ERAS is not fully explained. The aim of this study was to systematically review the available literature regarding prehabilitation interventions in patients undergoing abdominal surgery within ERAS and to examine the effect of the interventions on recovery.

Method Relevant studies were identified through a search on MEDLINE, EMBASE, AMED, CINAHL and pubmed. All randomised controlled trials (RCT) and non-RCT studies in abdominal surgery that had prehabilitation intervention (s) within ERAS were included. Descriptive characteristics such as participants characteristics, study design, speciality, type and mode of the intervention, outcome measure and follow up were extracted. Methodological evaluation of the studies was performed using Jadad score.

Results 11 studies were included consisting of 1105 patients (680 had some form of intervention) from 7 RCT and 4 non-RCT across four different specialities (colorectal, gastric, liver and bladder surgery). There was a wide variation in the mode, type, duration, outcome measure and follow up period of the interventions. Five studies included structured aerobic programme and two studies included only nutritional enhancing regimes while four had combined modalities. Median duration of the intervention was 4 weeks prior to surgery and four studies extended the intervention to the postoperative period. Outcome measures included functional recovery and quality of life (4); clinical outcomes (4) and cardiopulmonary fitness (3). Seven studies showed improvement in the functional capacity and/or clinical outcomes due to the intervention, particularly in patients with low initial fitness.

Conclusion Addition of prehabilitation programme to ERAS may offer additional benefits to traditional ERAS. Further research is required to investigate the optimum intervention of rehabilitation within ERAS.

Disclosure of interest None Declared.

References

1. Li C, et al. Trimodal prehabilitation program improves functional recovery in colorectal cancer surgery: A pilot study. Surg Endosc Other Intervent Tech.2012;26(S243):0930-2794

2. Kaibori M, et al. Perioperative exercise for chronic liver injury patients with hepatocellular carcinoma undergoing hepatectomy. Am J Surg. 2013;206(2):202–9

3. Gillis C, et al. Prehabilitation versus rehabilitation: A randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 2014;121(5):937-47