Does prehabilitation improve outcomes in cardiac surgical patients?

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: does prehabilitation improve outcomes in cardiac surgical patients? Altogether more than 483 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four meta-analyses concluded that prehabilitation reduced postoperative pulmonary complications (PPCs). The 6 randomized controlled trials (RCT) included, differed significantly in the type of prehabilitation delivered. There was replication of some RCTs across the meta-analyses. The consensus across the meta-analyses was a reduction in PPCs and 3 of 4 meta-analyses finding a reduction in length of stay (LOS). There were no adverse events or difference in mortality found. Two small RCTs showed feasibility and modest improvements in physiological parameters. Three RCTs demonstrated a reduction in LOS and a reduction in PPCs. One RCT found no difference in quality of life scores, LOS or postoperative atrial fibrillation. None of the RCTs found negative evidence of prehabilitation interventions. We conclude that the prehabilitation is a positive preoperative intervention, most favourably in older patients and in those who are at risk of PPCs. Specifically inspiratory muscle training is the intervention with most favourable evidence.