Prehabilitation for general surgery: a systematic review of randomized controlled trials

Abstract

BackgroundPrehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline‐level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery.MethodsThis study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta‐analysis was precluded due to heterogeneity across included studies.ResultsFrom 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%).ConclusionsPrehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system‐level delivery across General Surgery within standardized protocols. However, given potential benefits and non‐inferiority to standard care, they should be considered on a case‐by‐case basis.

Artificial Empathy: User Experiences with Emotionally Intelligent Chatbots

“…The exploration of emotionally intelligent chatbots in this study unveils a complex landscape where the potential of artificial empathy intersects with the nuanced requirements of authentic human-AI interactions. Our findings underscore the burgeoning role of chatbots equipped with artificial empathy across diverse domains, such as healthcare, customer service, and counseling, corroborating the assertions of Ayers et al (2023), Kovoor (2023), andMorrow et al (2023) (Ayers et al, 2023;Kovoor, 2023;Morrow et al, 2023). These applications not only highlight the versatility of emotionally intelligent chatbots but also signal a shift towards more empathetic and human-centric AI interactions.…”

“…Artificial empathy, as defined by Pentina et al (2023), refers to the capability of AI agents to recognize, understand, and react I to users' cognitive and emotional states, fostering interactions that are not only meaningful but also seemingly empathetic (Pentina et al, 2023). This advancement heralds a new era in human-computer interaction, where chatbots are not mere tools for information retrieval but empathetic companions capable of providing support and understanding (Ayers et al, 2023;Kovoor, 2023;Morrow et al, 2023).…”

Prehabilitation: tertiary prevention matters

“…Initially, the main focus of prehabilitation programmes was exercise-based prehabilitation. Most of these programmes were unimodal, addressing only aerobic fitness 24 . Prehabilitation as a multimodal intervention to withstand the surgical stress of an operation is, however, more than improving cardiorespiratory fitness and muscle function alone.…”

“…It also involves looking at other patient-related modifiable risk factors. Over time, the focus has shifted towards multimodal programmes, allowing for a more holistic patient approach 24 . These programmes often consist of a combination of interventions targeting modifiable risk factors, including two or more of the following: an exercise programme; a dietary intervention focused on improving nutritional status; a psychological programme improving mental resilience; treatment of anaemia; optimization of poorly regulated co-morbidities, such as diabetes; screening for frailty; and guidance on quitting smoking and alcohol.…”

Textbook Neoadjuvant Outcome—Novel Composite Measure of Oncological Outcomes among Gastric Cancer Patients Undergoing Multimodal Treatment

“…The main objective is to optimize patients' fitness and prepare them for metabolic stress and surgical trauma, thereby enhancing adherence to perioperative chemotherapy. A systematic review of randomized controlled trials of prehabilitation incorporated a range of exercise training and psychological and nutritional interventions with diverse effectiveness [68]. Despite the absence of a standardized protocol, this multifaceted approach proves non-inferior to the established standard of care and merits consideration as an integral component of contemporary patient-centered healthcare.…”