Psychological prehabilitation can significantly enhance recovery after surgery

A new analysis led by surgeons at UCLA Health finds that psychological prehabilitation can significantly enhance recovery after surgery. The research, led by Anne E. Hall in the lab of Dr. Justine Lee analyzed data from 20 randomized controlled trials (RCTs) conducted between 2004 and 2024, involving a total of 2,376 patients. It is published in the Annals of Surgery

What is psychological prehabilitation? Prehabilitation is a proactive approach aimed at improving surgical outcomes through preventive measures. Traditionally, it has focused on physical function and patient education. However, mental health has recently gained attention due to its crucial role in postoperative recovery, including reducing persistent opioid use.

Study methods The researchers conducted a systematic review, meta-analysis, and meta-regression of RCTs retrieved from databases such as MEDLINE, EMBASE, CENTRAL, and Google Scholar. They included studies with more than 50 adult surgical patients and evaluated the effects of different preoperative psychotherapy-based interventions, including cognitive behavioral therapy (CBT), supportive psychotherapy, and acceptance and commitment therapy (ACT), on postoperative outcomes.

Key findings The study found that psychological prehabilitation significantly reduces the length of hospital stay, pain, anxiety, and depression after surgery. Specifically, the analysis showed:

• A reduction in length of hospital stay (LOS) by an average of 1.62 days;
• A decrease in pain by an average of 3.52 points;
• Lower anxiety levels regardless of which validated anxiety scale was used;
• Reduced depression levels regardless of which validated depression scale was used.

Interestingly, the type of psychotherapy and the kind of surgery did not significantly affect the outcomes, except for anxiety.

Implications for healthcare The findings suggest that incorporating psychological prehabilitation into pre-surgery routines could lead to better overall recovery for patients. This approach may also help reduce healthcare costs associated with prolonged hospital stays and postoperative complications.

Future research The study highlights the need for further research to compare different types, durations, and delivery methods of psychotherapy to determine the most effective strategies for specific postoperative outcomes.