Evidence map›Paper›PMID 34593498›Full record

SynthesisBMJ open2021

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 and 3 more

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 7 pooled it
12.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

55 citing papers in PubMed, 7 syntheses or guidelines pooled it, 105 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. The effects of psychological intervention on negative emotions, pain, and sleep in patients with advanced colon cancer.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025
    Trial
  9. Prehabilitation for Limb Salvage Surgery: A Practical and Evidence-based Guide.Plastic and reconstructive surgery. Global open · 2026
    Article
  10. Prehabilitation in Head and Neck Surgery and Reconstruction.Plastic and reconstructive surgery. Global open · 2026
    Article
  11. Article
  12. Preoperative prehabilitation in adults: A concept analysis.International journal of nursing studies advances · 2026
    Review
  13. Observational
  14. Article
  15. Article
  16. Article
  17. Article
  18. [S1 guideline on sustainability in intensive care and emergency medicine].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025
    Review
  19. Article
  20. Priorities for prehabilitation for patients with upper gastrointestinal cancer: a nominal group consensus study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 2 countries.

Rachel PerryNIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.ORCID 0000-0001-5874-3016
Georgia HerbertNIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.
Charlotte AtkinsonNIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.
Clare EnglandNIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.
Kate NorthstonePopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Sarah BaosBristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK.
Tim BrushBristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK.
Amanda ChongNIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.
Andy NessNIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.
Jessica HarrisBristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK.
Anne HaaseFaculty of Health, Victoria University of Wellington, Wellington, New Zealand.
Sanjoy ShahUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.
Maria PufuleteBristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK maria.pufulete@bristol.ac.uk.
University Hospitals Bristol NHS Foundation Trust · GBUniversity of Bristol · GBAt Bristol · GBUniversity Of Bristol Dental Hospital · GBVictoria University of Wellington · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery.

designSystematic review and meta-analysis of randomised controlled trials (RCTs) (published or unpublished). We searched Medline, Embase, CENTRAL, DARE, HTA and NHS EED, The Cochrane Library, CINAHL, PsychINFO and ISI Web of Science (June 2020).

settingSecondary care.

participantsPatients (≥18 years) undergoing major elective surgery (curative or palliative).

interventionsAny intervention administered in the preoperative period with the aim of improving postoperative outcomes. OUTCOMES AND MEASURES: Primary outcomes were 30-day mortality, hospital length of stay (LoS) and postoperative complications. Secondary outcomes included LoS in intensive care unit or high dependency unit, perioperative morbidity, hospital readmission, postoperative pain, heath-related quality of life, outcomes specific to the intervention, intervention-specific adverse events and resource use. REVIEW

methodsTwo authors independently extracted data from eligible RCTs and assessed risk of bias and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Random-effects meta-analyses were used to pool data across trials.

results178 RCTs including eight types of intervention were included. Inspiratory muscle training (IMT), immunonutrition and multimodal interventions reduced hospital LoS (mean difference vs usual care: -1.81 days, 95% CI -2.31 to -1.31; -2.11 days, 95% CI -3.07 to -1.15; -1.67 days, 95% CI -2.31 to -1.03, respectively). Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications (RR 0.55, 95% CI 0.38 to 0.80, and RR 0.54, 95% CI 0.39 to 0.75, respectively). Smoking cessation interventions reduced wound infections (RR 0.28, 95% CI 0.12 to 0.64).

conclusionsSome prehabilitation interventions may reduce postoperative LoS and complications but the quality of the evidence was low. PROSPERO REGISTRATION NUMBER: CRD42015019191.

Indexed as

Elective Surgical ProceduresPreoperative ExerciseExerciseHumansLength of StayPostoperative Complicationscardiologygastroenterologyoncologyorthopaedic & trauma surgerypain managementpreventive medicine

Identifiers

PMID34593498
PMCPMC8487197
OpenAlexW3203322874

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.