The Impact of Psychological Prehabilitation on Surgical Outcomes

OBJECTIVE: To investigate the efficacy of psychological prehabilitation in improving surgical outcomes. BACKGROUND: Prehabilitation aims to improve surgical outcomes through prevention. While most prehabilitation protocols have focused on improving patient knowledge and physical function, mental health has started to receive greater attention due to its effects on postoperative recovery, including persistent opioid use. However, the efficacy of psychological prehabilitation remains unclear due to the heterogeneity of psychological modalities, intervention characteristics, and surgical contexts. METHODS: A systematic review, meta-analysis, and meta-regression of randomized controlled trials from 2004 to 2024 were conducted per "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines to assess the effect of psychotherapy on 4 postoperative outcomes: length of stay (LOS), pain, anxiety, and depression. Randomized controlled trials were retrieved from MEDLINE, EMBASE, CENTRAL, and Google Scholar databases (March 2024). Studies with >50 adult surgical patients were included. Random effect meta-analyses estimated pooled effect sizes, with meta-regression analyzing intervention and surgery types. RESULTS: Twenty articles comprising 2376 patients were included. Psychological prehabilitation interventions included cognitive behavioral therapy (70%), supportive psychotherapy (25%), and acceptance and commitment therapy (5%). Pooled analysis revealed greater reductions in LOS [mean difference (MD) = -1.62 days; 95% CI: -2.899, -0.349; P = 0.012], pain (MD = -3.52; 95% CI: -2.642, -4.401; P < 0.001), anxiety (standard MD = -1.51; 95% CI: -0.634, -2.385; P < 0.001), and depression (standard MD = -1.48; 95% CI: -0.578, -2.382; P = 0.001). Psychotherapy modality and surgery type showed no significant effects, except for anxiety. CONCLUSIONS: Psychological prehabilitation reduces LOS, pain, anxiety, and depression after surgery. Further studies are necessary to compare different types, durations, and delivery methods of psychotherapy for specific postoperative outcomes of interest.