Can preoperative optimization improve abdominal wall surgery outcomes? a qualitative systematic review.

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not calculable due to heterogeneity

• Primary Outcome: Preoperative optimization interventions were highly heterogeneous, primarily multidisciplinary programs with exercise, weight loss, and lifestyle modification

• Nnt Or Sensitivity: Unsuccessful rehabilitation rates: 5.1%-45% in studies with predefined targets

• Confidence Interval: Not reported

Clinical Application

Limited by lack of standardized protocols and variable resource requirements for multidisciplinary programs Relevant to Australian practice given similar surgical populations, but implementation would require adaptation to local healthcare systems and potentially PBS consideration for structured programs Patients with modifiable risk factors undergoing elective ventral hernia repair

Abstract

BACKGROUND: Ventral hernia repair (VHR) is commonly performed in patients with multiple modifiable risk factors. Preoperative rehabilitation programs aim to optimize these risk factors and improve surgical outcomes; however, their implementation and effectiveness remain variable. This systematic review evaluates current evidence on the role of preoperative optimization in patients undergoing VHR. MATERIALS AND METHODS: Cochrane Central, Embase, and PubMed were searched for studies comparing preoperative interventions versus standard care in patients undergoing VHR. The primary outcome was characterization of rehabilitation strategies. Secondary outcomes included surgical utilization, emergent repair, readmission, surgical site infection (SSI), surgical site occurrence (SSO), recurrence, reoperation, and mortality. RESULTS: Six studies were included, comprising a total of 3,556 patients, of whom 1,805 (50.7%) underwent preoperative optimization. Preoperative optimization interventions were highly heterogeneous and primarily consisted of multidisciplinary programs focused on exercise, weight loss, and lifestyle modification. Control groups varied widely, precluding formal meta-analysis. Studies requiring predefined optimization targets reported unsuccessful rehabilitation rates of 5.1%-45%. Emergent repair occurred in 6.8% of intervention patients in one study. SSI rates seemed lower and ranged from 4.2% to 11.8% in intervention groups versus 11.0%-16.7% in controls, SSO and reoperation rates were generally lower in optimization groups. CONCLUSION: Structured preoperative optimization pathways may be associated with improved short-term outcomes in select patients undergoing VHR. However, the current literature is heterogeneous, and standardized protocols and prospective studies are needed to better define optimal implementation strategies and long-term effectiveness.

References

1. 1.Eguchi, M., de Macedo Torves, M., Wilmsen, C., Duarte, J., Nogueira, R., Sanha, V., Cavazzola, L., Malcher, F., & Lima, D. L. (2026). Can preoperative optimization improve abdominal wall surgery outcomes? a qualitative systematic review. Hernia, advance online publication. https://doi.org/10.1056/NEJMoa2505669