Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery: A Systematic Review and Meta-analysis with Trial Sequential Analysis.

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Serval ID
serval:BIB_C48F37E60AB1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery: A Systematic Review and Meta-analysis with Trial Sequential Analysis.
Journal
Annals of the American Thoracic Society
Author(s)
Assouline B., Cools E., Schorer R., Kayser B., Elia N., Licker M.
ISSN
2325-6621 (Electronic)
ISSN-L
2325-6621
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Preoperative poor physical fitness and respiratory muscle weakness are associated with postoperative pulmonary complications that result in prolonged hospital length of stay and increased mortality.
Examine the effect of preoperative exercise training on the risk of postoperative pulmonary complications across different surgical settings.
We searched MEDLINE, Web of Science, Embase, Pedro, and the Cochrane Central Register, without language restrictions, for studies from inception to July, 2020. We included randomized controlled trials that compared patients receiving exercise training with those receiving usual care or sham training before cardiac, lung, esophageal, or abdominal surgery. Postoperative pulmonary complications were the main outcome; secondary outcomes were preoperative functional changes, postoperative mortality, cardiovascular complications and hospital length of stay. The study was registered with PROSPERO (N° CRD42018096956).
From 29 studies, 2'070 patients were pooled for meta-analysis. Compared to the control group, preoperative exercise training was associated with a lower incidence of postoperative pulmonary complications (23 studies, 1'864 patients, [RR] 0.52; 95% CI 0.41-0.66, grading of evidence: moderate); Trial Sequential Analysis confirmed effectiveness and there was no evidence of difference of effect across surgeries, type of training (respiratory muscles, endurance or combined) and preoperative duration of training. At the end of the preoperative period, exercise training resulted in increased peak oxygen uptake (weighted mean difference [WMD] +2 ml/kg/min, 99%CI 0.3 to 3.7) and higher maximal inspiratory pressure (WMD +12.2 cmH20, 99%CI 6.3 to 18.2). Hospital length of stay was shortened (WMD -2.3 days 99%CI -3.82 to -0.75) in the intervention group whereas no difference was found in postoperative mortality.
Preoperative exercise training improves physical fitness and reduces the risk to develop postoperative pulmonary complications while minimizing hospital resources utilization regardless of the type of intervention and surgery performed.
Pubmed
Create date
24/11/2020 12:39
Last modification date
28/11/2020 7:10
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