Efficacy of prehabilitation prior to cardiac surgery: a systematic review and meta-analysis

OBJECTIVE: Patients awaiting cardiac surgery seem to benefit from exercise-based-prehabilitation (EBPrehab) but the impact on different perioperative outcomes compared to standard care is still unclear.

DESIGN: Eligible non-/randomized controlled studies investigating the impact of EBPrehab in adults scheduled for elective cardiac surgery were searched on 16th december 2020 from electronic databases, including MEDLINE, CENTRAL and CINAHL. The data were pooled and a meta-analysis was conducted.

RESULTS: Out of 1.490 abstracts six studies (n = 665) were included into the review and meta-analysis. At post-intervention-interval and at post-surgery-interval, 6-minute-walking-distance (6MWD) improved significantly in EBPrehab-group compared to controls (mean difference (MD) = 75.4 m, 95% CI, 13.7-137.1 m; p = 0.02 and 30.5 m, 95% CI, 8.5-52.6 m; p = 0.007, respectively). Length of hospital stay (LOS) was significantly shorter in EBPrehab-group (MD = -1.00 day, 95% CI, -1.78 to -0.23; p = 0.01). Participation in EBPrehab revealed a significant decrease in the risk of postoperative atrial fibrillation (AF) in patients ≤65 years (risk ratio = 0.34, 95% CI, 0.14-0.83; p = 0.02).

CONCLUSION: The participation in EBPrehab significantly improves post-intervention and post-surgery 6MWD, LOS and decreases the risk of postoperative AF in patients ≤65 years compared to controls.