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Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)

Mechanisms of Multi-modal Prehabilitation Effects on Surgical Complications: A Narrative Review

Thursday, November 10, 2022

3:56 PM – 4:01 PM

Location: Station 3

Presenting Author(s)

Daniel Sibley, RKin, MSc

Doctoral Candidate
University of Toronto, Canada; University Health Network, Canada
Toronto, Ontario, Canada

Non-presenting Author(s)

Maggie M. Chen, RKin

Registered Kinesiologist, Graduate Student Researcher
University Health Network
Toronto, Ontario, Canada
Daniel Santa Mina, RKin, CSEP-CEP, PhD

Associate Professor; Clinician Investigator
University of Toronto; Toronto General Hospital
Toronto, Ontario, United States
CG

Chelsia Gillis, MSc PhD RD CNSC

Assistant Professor
McGill University, Canada
AM

Andrew Matthew, PhD, C.Psych

Psychologist, Lead, Depts. of Surgical Oncology and Supportive Care Associate Professor, Depts. of
University of Toronto; Princess Margaret Cancer Centre, United States

Non-presenting author(s)

MW

Malcolm West

Non-presenting Author(s)

IR

Ian M. Randall, MD MPH FRCPC

Assistant Professor
Department of Anesthesia and Pain Medicine, Faculty of Medicine, University of Toronto
Toronto, Ontario, Canada

Objective(s): In this narrative review, we synthesize the evidence for the biological plausibility of multimodal prehabilitation to reduce surgical complications. The goal of this review is to improve prehabilitation interventions by outlining biologically plausible mechanisms of benefit and generating hypotheses for future research.

Data Sources: Studies that contributed to this review were identified using Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PEDro (Physiotherapy Evidence database), and Google Scholar. The search was limited to articles published prior to March 2022 and in English. Searches were conducted using component blocks of terms, for instance: “mechanisms” and “preoperative” and “exercise” or “nutrition” or “psychological intervention.” These terms were combined with the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) list of surgical complication terms using the Boolean Operator “AND”.

Study Selection: All study designs were considered for this review. Studies were included if they reported on a prehabilitation intervention for adult surgical patients (≥ 18 years old). Prehabilitation modalities were broadly defined as an exercise, nutrition, or psychological intervention that were or could be initiated preoperatively with the aim of preventing surgical complications.

Data Extraction: Data were independently extracted and synthesized by two (DS and MC) and four (DS, MC, DSM, and IR) reviewers, respectively. Data synthesis was revised and approved by all other authors with domain expertise.

Data Synthesis: We summarized the biological rationale of prehabilitation to reduce each surgical complication listed in the ACS-NSQIP quality improvement program.

Conclusions: This review reports the mechanisms by which prehabilitation may reduce surgical complications and proposes untested mechanisms with biological plausibility. The untested mechanisms highlighted in this review remain critical areas for future research.

Author(s) Disclosures: None.

Learning Objectives:

Upon completion, participants will be able to explain the physiological mechanisms of prehabilitation effects on the prevention of surgical complications.
Upon completion, participants will be able to identify relevant mechanisms and biomarkers to be targeted by future prehabilitation trials seeking to improve surgical patient health and recovery.
Upon completion, participants will be able to describe the physiological impact of exercise, nutrition, and psychological intervention on various organ systems.