부산대학교 도서관

Background:Hepato-pancreatico-biliary(HPB)patients experience significant risk of preoperative frailty.Studies assessing preventative prehabilitation in HPB populations are limited.This systematic review and meta-analysis evaluates outcomes for HPB patients treated with exercise prehabilitation.Data sources:A comprehensive search of MEDLINE(via Ovid),Embase(Ovid),Scopus,Web of Science Core Collection,Cochrane Library(Wiley),ProQuest Dissertations,Theses Global,and Google Scholar was conducted with review and extraction following PRISMA guidelines.Included studies evaluated more than 5 adult HPB patients undergoing≥7-day exercise prehabilitation.The primary outcome was postopera-tive length of stay(LOS);secondary outcomes included complications,mortality,physical performance,and quality of life.Results:We evaluated 1778 titles and abstracts and selected 6(randomized controlled trial,n = 3;prospective cohort,n = 1;retrospective cohort,n = 2)that included 957 patients.Of those,536 pa-tients(56.0％)underwent exercise prehabilitation and 421(44.0％)received standard care.Patients in both groups were similar with regards to important demographic factors.Prehabilitation was associated with a 5.20-day LOS reduction(P = 0.03);when outliers were removed,LOS reduction decreased to 1.85 days and was non-statistically significant(P = 0.34).Postoperative complications(OR = 0.70;95％CI:0.39 to 1.26;P = 0.23),major complications(OR = 0.83;95％CI:0.60 to 1.14;P = 0.24),and mortality(OR = 0.67;95％CI:0.17 to 2.70;P = 0.57)were similar.Prehabilitation was associated with improved strength,car-diopulmonary function,quality of life,and alleviated sarcopenia.Conclusions:Exercise prehabilitation may reduce LOS and morbidity following HPB surgery.Studies with well-defined exercise regimens are needed to optimize exercise prehabilitation outcomes.