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Impact on postoperative complications of combined prehabilitation targeting co-existing smoking, malnutrition, obesity, alcohol drinking, and physical inactivity : a systematic review and meta-analysis of randomised trials

Lydom, Line N. ; Jensen, Sofie Anne Marie S. ; Lauridsen, Susanne V. ; Rasmussen, Mette LU orcid ; Christensen, Robin ; Joensen, Ulla N. ; Rosenberg, Jacob and Tønnesen, Hanne LU (2025) In F1000Research 13.
Abstract

Background: This study aimed to compare the effect on postoperative complications of combined prehabilitation targeting predefined co-existing risky SNAP factors with usual preoperative routines in surgical patients. Methods: This systematic review followed the PRISMA 2020 guideline and the protocol (CRD42022282611). Five databases were searched from inception to November 7, 2022 for randomised controlled trials on prehabilitation targeting ≥2 predefined risky lifestyles compared with usual preoperative routines. Risky lifestyles included Smoking, Nutrition (malnutrition and/or BMI>25), risky Alcohol intake, and Physical inactivity (SNAP). Primary outcome was postoperative complications ≤30 days. Cochrane’s risk-of-bias tool 2 was... (More)

Background: This study aimed to compare the effect on postoperative complications of combined prehabilitation targeting predefined co-existing risky SNAP factors with usual preoperative routines in surgical patients. Methods: This systematic review followed the PRISMA 2020 guideline and the protocol (CRD42022282611). Five databases were searched from inception to November 7, 2022 for randomised controlled trials on prehabilitation targeting ≥2 predefined risky lifestyles compared with usual preoperative routines. Risky lifestyles included Smoking, Nutrition (malnutrition and/or BMI>25), risky Alcohol intake, and Physical inactivity (SNAP). Primary outcome was postoperative complications ≤30 days. Cochrane’s risk-of-bias tool 2 was used and meta-analyses were conducted. GRADE was used to assess certainty of evidence. Results: The search resulted in 20,862 records. At full-text screening, only two (120 participants) of 24 identified trials on combined SNAP intervention had ≥2 predefined risk factors and were included. One (n=110) on intensive physical and brief nutritional intervention to frail patients with colorectal cancer resection reported complication rates of 45% in both groups (relative risk (RR) 1.00, 95% CI 0.66 to 1.51). The other study (n=10, subgroup) on intensive alcohol and smoking intervention in patients with bladder cancer undergoing radical cystectomy, reported complications in 3/7 vs 3/3 participants. The meta-analysis estimated a RR of 0.79 (95% CI 0.41 to 1.51, I 2 51%). Conclusion: Two small of the 24 trials on prehabilitation targeted co-existing and predefined risky SNAP factors and the effect on postoperative complications is very uncertain. Future prehabilitation research involving patient needs is warranted.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Lifestyle, Postoperative complications, Prehabilitation, Surgery
in
F1000Research
volume
13
article number
694
publisher
F1000 Research Ltd.
external identifiers
  • scopus:105009541249
  • pmid:40574788
ISSN
2046-1402
DOI
10.12688/f1000research.150880.2
language
English
LU publication?
yes
additional info
Publisher Copyright: Copyright: © 2025 Lydom LN et al.
id
7c02f55d-baf5-4561-b9e0-adb465a9f6c4
date added to LUP
2026-01-07 14:48:43
date last changed
2026-02-18 20:53:02
@article{7c02f55d-baf5-4561-b9e0-adb465a9f6c4,
  abstract     = {{<p>Background: This study aimed to compare the effect on postoperative complications of combined prehabilitation targeting predefined co-existing risky SNAP factors with usual preoperative routines in surgical patients. Methods: This systematic review followed the PRISMA 2020 guideline and the protocol (CRD42022282611). Five databases were searched from inception to November 7, 2022 for randomised controlled trials on prehabilitation targeting ≥2 predefined risky lifestyles compared with usual preoperative routines. Risky lifestyles included Smoking, Nutrition (malnutrition and/or BMI&gt;25), risky Alcohol intake, and Physical inactivity (SNAP). Primary outcome was postoperative complications ≤30 days. Cochrane’s risk-of-bias tool 2 was used and meta-analyses were conducted. GRADE was used to assess certainty of evidence. Results: The search resulted in 20,862 records. At full-text screening, only two (120 participants) of 24 identified trials on combined SNAP intervention had ≥2 predefined risk factors and were included. One (n=110) on intensive physical and brief nutritional intervention to frail patients with colorectal cancer resection reported complication rates of 45% in both groups (relative risk (RR) 1.00, 95% CI 0.66 to 1.51). The other study (n=10, subgroup) on intensive alcohol and smoking intervention in patients with bladder cancer undergoing radical cystectomy, reported complications in 3/7 vs 3/3 participants. The meta-analysis estimated a RR of 0.79 (95% CI 0.41 to 1.51, I <sup>2</sup> 51%). Conclusion: Two small of the 24 trials on prehabilitation targeted co-existing and predefined risky SNAP factors and the effect on postoperative complications is very uncertain. Future prehabilitation research involving patient needs is warranted.</p>}},
  author       = {{Lydom, Line N. and Jensen, Sofie Anne Marie S. and Lauridsen, Susanne V. and Rasmussen, Mette and Christensen, Robin and Joensen, Ulla N. and Rosenberg, Jacob and Tønnesen, Hanne}},
  issn         = {{2046-1402}},
  keywords     = {{Lifestyle; Postoperative complications; Prehabilitation; Surgery}},
  language     = {{eng}},
  publisher    = {{F1000 Research Ltd.}},
  series       = {{F1000Research}},
  title        = {{Impact on postoperative complications of combined prehabilitation targeting co-existing smoking, malnutrition, obesity, alcohol drinking, and physical inactivity : a systematic review and meta-analysis of randomised trials}},
  url          = {{http://dx.doi.org/10.12688/f1000research.150880.2}},
  doi          = {{10.12688/f1000research.150880.2}},
  volume       = {{13}},
  year         = {{2025}},
}