SEARCHMETA-ANALYSISsurgery, systematic review

meta-analysis·surgery, systematic review, meta-analysis, public health, clinical trial·PMC10321619

The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: A systematic review and meta-analyses

PLOS ONE · 14 authors, 7 centres

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TL;DR

This systematic review and meta-analysis evaluated 67 randomized controlled trials of preoperative behavioural prehabilitation interventions.

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This systematic review and meta-analysis evaluated 67 randomized controlled trials of preoperative behavioural prehabilitation interventions. The meta-analyses showed that interventions reduced pre-surgery length of stay by 1.5 days, but a sensitivity analysis indicated this reduction was primarily observed for lung cancer surgery. Pre-surgery, the intervention group demonstrated a 31.8-meter improvement in the six-minute walk test and a significantly higher rate of smoking cessation. Improvements in physical function were sustained to 4 weeks post-surgery, and greater smoking cessation was maintained at 12 months. No significant pre-surgery differences were found for quality of life or BMI. The authors conclude that while prehabilitation can improve functional capacity and smoking outcomes around surgery, more research is needed on other behaviours and long-term effects. Limitations include heterogeneity in the included trials and that only eight were judged to have a low risk of bias.

STUDY TYPE

meta-analysis

SPECIALTY

surgery

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ORIGINAL PAPER

PMC10321619

The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: A systematic review and meta-analyses

PLOS ONE

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ABSTRACT

Background Prehabilitation interventions are being delivered across surgical specialities to improve health risk behaviours leading to better surgical outcomes and potentially reduce length of hospital stay. Most previous research has focused on specific surgery specialities and has not considered the impact of interventions on health inequalities, nor whether prehabilitation improves health behaviour risk profiles beyond surgery. The aim of this review was to examine behavioural Prehabilitation interventions across surgeries to inform policy makers and commissioners of the best available evidence. Methods and findings A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to determine the effect of behavioural prehabilitation interventions targeting at least one of: smoking behaviour, alcohol use, physical activity, dietary intake (including weight loss interventions) on pre- and post-surgery health behaviours, health outcomes, and health inequalities. The comparator was usual care or no treatment. MEDLINE, PubMed, PsychINFO, CINAHL, Web of Science, Google Scholar, Clinical trials and Embase databases were searched from inception to May 2021, and the MEDLINE search was updated twice, most recently in March 2023. Two reviewers independently identified eligible studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tool. Outcomes were length of stay, six-minute walk test, behaviours (smoking, diet, physical activity, weight change, and alcohol), and quality of life. Sixty-seven trials were included; 49 interventions targeted a single behaviour and 18 targeted multiple behaviours. No trials examined effects by equality measures. Length of stay in the intervention group was 1.5 days shorter than the comparator (n = 9 trials, 95% CI -2.6 to -0.4, p = 0.01, I 2 83%), although in sensitivity analysis prehabilitation had the most impact in lung cancer patients (-3.5 days). Pre-surgery, there was a mean difference of 31.8 m in the six-minute walk test favouring the prehabilitation group (n = 19 trials, 95% CI 21.2 to 42.4m, I 2 55%, P <0.001) and this was sustained to 4-weeks post-surgery (n = 9 trials, mean difference = 34.4m (95%CI 12.8 to 56.0, I 2 72%, P = 0.002)). Smoking cessation was greater in the prehabilitation group before surgery (RR 2.9, 95% CI 1.7 to 4.8, I 2 84%), and this was sustained at 12 months post-surgery (RR 1.74 (95% CI 1.20 to 2.55, I 2 43%, Tau 2 0.09, p = 0.004)There was no difference in pre-surgery quality of life (n = 12 trials) or BMI (n = 4 trials). Conclusions Behavioural prehabilitation interventions reduced length of stay by 1.5 days, although in sensitivity analysis the difference was only found for Prehabilitation interventions for lung cancer. Prehabilitation can improve functional capacity and smoking outcomes just before surgery. That improvements in smoking outcomes were sustained at 12-months post-surgery suggests that the surgical encounter holds promise as a teachable moment for longer-term behavioural change. Given the paucity of data on the effects on other behavioural risk factors, more research grounded in behavioural science and with longer-term follow-up is needed to further investigate this potential.

CITATION EXPORT

Mackenzie Fong, Eileen Kaner, Maisie Rowland et al.. The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: A systematic review and meta-analyses. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0286757

AUTHORS

14 · 7 CENTRES

Mackenzie Fong, Eileen Kaner, Maisie Rowland, Henrietta E. Graham, Louise McEvoy, Kate Hallsworth, Gabriel Cucato, Carla Gibney, Martina Nedkova, James Prentis, Claire D. Madigan, Dario Ummarino, PhD, Favil Singh, Favil Singh

1 NIHR Applied Research Collaboration, North East and North Cumbria, United Kingdom
2 Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
3 Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
4 NIHR Newcastle BRC, Newcastle upon Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
5 Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
6 Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle Upon Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
Edith Cowan University - Joondalup Campus: Edith Cowan University, AUSTRALIA

EDITOR / REVIEWER

Favil Singh