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Prehabilitation in hepato-pancreato-biliary surgery: A systematic review and meta-analysis. A necessary step forward evidence-based sample size calculation for future trials - 29/09/22

Doi : 10.1016/j.jviscsurg.2021.07.003 
C. Dagorno a, b, D. Sommacale a, b, c, A. Laurent a, b, A. Attias d, N. Mongardon a, d, e, E. Levesque a, d, O. Langeron a, d, R. Rhaiem f, V. Leroy a, c, g, G. Amaddeo a, c, g, R. Brustia b,
a Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France 
b Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France 
c Inserm U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, France–Assistance Publique-Hôpitaux de Paris, Créteil, France 
d Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France 
e U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm, University Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France 
f Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, Reims, France 
g Department of Hepatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France 

Corresponding author.

Summary

Introduction

Prehabilitation is defined as preoperative conditioning of patients in order to improve post-operative outcomes. Some studies showed an increase in functional recovery following colorectal surgery, but its effect in hepato-pancreato-biliary (HPB) surgery is unclear. The aim of this study was to realize a systematic literature review and meta-analysis on the current available evidence on prehabilitation in HPB surgery.

Materials and methods

A systematic review and a metanalysis were carried out on prehabilitation (physical, nutritional and psychological interventions) in HPB surgery (2009-2019). Assessed outcomes were postoperative complications, length of stay (LOS), 30-day readmission, and mortality.

Main results

Four studies among the 191 screened were included in this systematic review (3 randomized controlled trials, 1 case-control propensity score study), involving 419 patients (prehabilitation group, n=139; control group, n=280). After pooling, no difference was observed on LOS ((−4.37 days [95% CI: −8.86; 0.13]) or postoperative complications (RR 0.83 [95%CI: 0.62; 1.10]), reported by all the included studies. Two trials reported on readmission rate, but given the high heterogeneity, a meta-analysis was not realized. No deaths were reported among the included studies.

Conclusion

No effect of prehabilitation programs in HPB surgery was observed on LOS or postoperative complications rate. Future trials with standardized outcomes of measure, and adequately powered samples calculations are thus required.

PROSPERO registration

CRD42020165218.

El texto completo de este artículo está disponible en PDF.

Keywords : Prehabilitation, Enhanced recovery after surgery, Liver surgery, Pancreatic surgery, Patient recovery


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Vol 159 - N° 5

P. 362-372 - octobre 2022 Regresar al número
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