Preoperative pathways in adults with multiple long-term conditions undergoing major surgery: a systematic review.
Nataysia Maria Mikula-Noble, Stella Arakelyan, Rose Penfold et al.
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In 30 seconds
This systematic review examined preoperative interventions, pathways and protocols for adults with multiple long-term conditions (MLTCs) undergoing major surgery. Of 138 studies identifying surgical cohorts with MLTCs, 34 were included. Six (18%) discussed preoperative interventions in mixed MLTC and non-MLTC cohorts, while three (9%) reported applying interventions designed for the general surgical population to patients with MLTCs. The review found little evidence of interventions specifically developed for this population; some studies suggested general-population interventions may improve outcomes, but the evidence does not establish which approaches are appropriate for adults with MLTCs.
Key findings
- Of 138 studies identifying adults with MLTCs undergoing major surgery, 34 were included in the review.
- Six (18%) studies discussed preoperative interventions in mixed cohorts of patients with and without MLTCs.
- Three (9%) reported using preoperative interventions designed for the general surgical population in patients with MLTCs.
- The review found a paucity of data on interventions specifically identified for patients with MLTCs.
Why it matters
Adults with MLTCs have higher postoperative complication risk than adults without MLTCs, yet the review found little evidence to guide preoperative care specifically for this group. Clarifying whether existing general surgical pathways apply to patients with MLTCs, or whether tailored approaches are needed, could help direct research toward better-supported perioperative care.
What to keep in mind
Definitions of multimorbidity varied across the literature, which the authors note may have led to under-identification of relevant interventions.