Effectiveness of preoperative rehabilitation interventions in major abdominal surgery: a systematic review and Bayesian network meta-analysis

Preoperative rehabilitation interventions are widely used to optimize the postoperative recovery of patients undergoing major abdominal surgery. Although existing studies have explored the effects of different pre-rehabilitation programs, it is still necessary to clarify which interventions are most effective and comprehensively evaluate their impacts. We conducted a systematic search across PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Web of Science from their inception until January 3, 2025. To analyze and visualize our results, we utilized the “BUGSnet” and “JAGS” packages within the R statistical software. Employing a random-effects model, we calculated effect sizes as odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Furthermore, we performed a quality assessment of this study using the RoB2 tool. Out of 852 studies screened, 32 studies were included in the final analysis. The findings revealed that only trimodal prehabilitation (including exercise, nutrition, and anxiety reduction strategies) significantly reduced the incidence of postoperative complications (OR: 0.45, 95% CrI: 0.24–0.76) and shortened hospital stay (MD: − 1.34, 95% CrI: − 2.15 to − 0.57). In addition, both trimodal prehabilitation and MICT + RT + BT not only significantly improved preoperative 6-min walking test scores but also maintained these effects 2-month post-surgery. Trimodal prehabilitation effectively reduces postoperative complications and hospital stay while, along with MICT + RT + BT, sustaining improvements in functional capacity. Research registration number This systematic review was registered in Prospero (CRD42024575332).