Effect of preoperative prehabilitation in adults undergoing cardiac surgery on physical status and perioperative complications: a systematic review and meta-analysis

BACKGROUND: Many patients scheduled for cardiac surgery have low cardiorespiratory fitness, which is associated with increased perioperative morbidity and mortality. There is limited evidence to suggest that prehabilitation can reduce perioperative complications. The objective was to evaluate the impact of prehabilitation comprising physical exercise on the cardiorespiratory fitness of cardiac patients, and on quality of life, hospital stay, postoperative complications and mortality. METHODS: A systematic review and meta-analysis, following the PRISMA statement, encompassing randomized controlled trials on prehabilitation for adult patients undergoing cardiac surgery. The protocol was pre-registered on Open Science Framework. RESULTS: We included eight studies comprising 894 patients. The prehabilitation group exhibited a greater improvement in preoperative six-minute walk test than the control group (MD 36.65 m; 95% CI 1.72, 71.58; P=0.04). The number of patients demonstrating a clinically relevant improvement was not significantly different between the groups (OR 1.86; 95% CI 0.82, 4.21). The prehabilitation group exhibited a shorter hospital stay (MD -1.01 days; 95% CI -2, -0.02; P=0.04). No differences were observed in other outcomes. Overall, the certainty of the evidence was low. CONCLUSIONS: Our findings suggest an association between prehabilitation and preoperative enhancement in cardiorespiratory fitness. However, the effect size is modest and may have marginal clinical significance. It remains unclear whether prehabilitation can improve clinical outcomes beyond the reduction of hospital length of stay. Further research is required to provide evidence of the efficacy of these programs.