Prehabilitation to improve outcomes after major elective surgery: a systematic review and meta-analysis

  • 12 October 2021

Interventions such as eating foods that promote a strong immune system and exercises that strengthen the muscles we use to breathe, could help lower the risk of complications or death after surgery and aid faster recovery, a newly published NIHR Bristol Biomedical Research Centre (BRC) study has found. These types of measures taken before surgery are known as ‘prehabilitation’.

Obesity, being elderly or frail, or having a chronic condition such as high blood pressure, diabetes or heart disease can greatly increase the risk of complications or death after surgery. The number of patients falling into this ‘at-risk’ category continues to grow each year so efforts to limit these associated complications are increasingly important.

Preventative measures currently used in healthcare primarily focus on post-surgery care. However, a team of researchers from across the Cardiovascular and Nutrition themes in the NIHR Bristol BRC have been exploring the benefits of prehabilitation. Prehabilitation could include increasing physical activity, promoting psychological wellbeing,  education about what happens during and after surgery, stopping smoking, changing diet, limiting or removing alcohol and resistance exercises to strengthen the muscles used for breathing.

To analyse the effectiveness of these interventions they conducted a systematic review of all studies on the use of prehabilitation before planned major surgery. Where it was possible to combine the results of different studies they evaluated the potential benefits and harms of these interventions and compared their effect on recovery and mortality.

The results showed that many of these prehabilitation measures had a positive influence on recovery. The most effective measures included exercises to strengthen the muscles we use to breathe and eating foods that promote a healthy immune system. However, the sample sizes of many of the studies were quite small meaning the quality of this evidence was low, even when combined.

Dr Maria Pufulete who conceived the study, said:

“With around 1.5 million major surgical procedures carried out in the UK each year, with an annual cost of about £5.6 billion, it’s important that patients have the best chance of recovering well from their surgery without further, costly complications.

“Although we were able to identify a relatively large number of studies to review, the sample sizes within these studies were often small. This means the quality of the evidence was low and that we need more evidence to ensure that future guidance and recommendations are robust and evidence-based.”


Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis

Rachel Perry, Georgia Herbert, Charlotte Atkinson, Clare England, Kate Northstone, Sarah Baos, Tim Brush, Amanda Chong, Andy Ness, Jessica Harris, Anna Haase, Sanjoy Shah and Maria Pufulete in BMJ Open