32 days (95% CI -2.36 to -0.28). However, in younger patients, preoperative intervention had no significant effect, with a pooled mean NVP-AUY922 difference of 0.07 days (95% CI -0.99 to 0.84), although significant heterogeneity was present in this analysis (I2 = 77%, p = 0.001). Meta-analysis of physical function was unable to be performed due to insufficient data and a lack of consistency in the selection of outcome measures.
The results of individual trials are discussed below. Cost effectiveness was only reported for trials of counselling, so these data are discussed in that section below. Preoperative education did not significantly change the pooled relative risk of developing postoperative pulmonary complications, 0.66 (95% CI 0.10 to 4.40). This was based on meta-analysis of data from two trials, as presented in Figure 6. See the eAddenda for Figure 6. Meta-analysis of two trials reporting time to extubation gave a pooled mean difference of 0.07 days in favour of the education, which was not statistically significant (95% CI -0.17
to 0.03), as presented in Figure 7. See the eAddenda for Figure 7. Meta-analysis of three trials reporting length of stay in hospital gave a pooled mean difference of 0.20 days in favour of usual care, but this difference was not statistically significant (95% CI -0.58 to 0.98), as presented in Figure 8. See the eAddenda for Figure 8. Two trials17 and 19 were unable to be included in this meta-analysis Selleckchem BIBW2992 due to limited reporting of the data. Christopherson and Pfeiffer19 reported a mean reduction of 0.4 days, which could be considered clinically significant. Only two trials reported on length of stay in ICU,19 and 20 with conflicting results. Rice et al20 reported that providing patients with a preoperative educational booklet did not significantly affect length of stay in ICU. Christopherson and Pfeiffer19 reported that only one of their two intervention groups had a significantly shorter length of stay in ICU (the group who received
the booklet 1 to 2 days pre-surgery). It must be noted that the average length of stay in this trial was 2.8 to 4.7 days, which is considerably longer than the majority of trials included in this Unoprostone review. Rice et al20 reported a statistically significant increase in ambulation on the fifth postoperative day in the intervention group. Costs were not reported by any trials that examined education. Herdy et al16 reported that preoperative exercise resulted in a shorter time to extubation with a mean of 0.73 days (SD 0.26) versus 0.93 days (SD 0.46), p = 0.04. There were conflicting findings from the two trials that examined hospital length of stay and meta-analysis was not possible due to the format of data reporting. Arthur et al21 delivered a twice weekly, eight-week supervised exercise program and reported a significant reduction in length of stay of one day.