Abstract / Summary
Abstract Background Major abdominal surgery (MAS) is associated with early postoperative muscle loss and impaired physical function. Electrical muscle stimulation (EMS) has been proposed as a promising intervention for mitigating these effects. However, evidence regarding its efficacy, safety, and prescription remains limited. This study aims to evaluate the effectiveness and safety of electrical muscle stimulation (EMS) following major abdominal surgery (MAS), and to describe the current EMS protocols used in this population. Methods A comprehensive search of MEDLINE, Embase, CINAHL, AMED, and the Cochrane Library was conducted up to January 2026, following PRISMA guidelines. Randomised-controlled trials (RCTs) and non-randomised interventional studies evaluating the effects of EMS following MAS were included. The certainty of evidence was assessed using the GRADE. Results Ten studies, including 372 patients, were analysed. This meta-analysis demonstrated that EMS significantly attenuated the postoperative decline in quadriceps thickness (2 studies, SMD = 0.83, 95% CI 0.27 to 1.39; p = 0.003) and improved 6-minute walk distance (5 studies, MD = 31.47 m, 95% CI 10.97 to 51.96; p = 0.003). EMS facilitated earlier mobilisation, with first walking and sitting after surgery occurring 1.56 (95% CI − 2.99 to − 0.19; p = 0.03) and 0.59 (95% CI − 0.98 to − 0.20; p = 0.003) days earlier compared with controls, respectively. EMS did not demonstrate superiority over controls in preserving quadriceps strength, quadriceps cross-sectional area, and grip strength ( p > 0.05). EMS had no significant effect on length of hospital stay and daily activities ( p > 0.05). Most studies reported no adverse events. The stimulation was initiated on the first postoperative day, targeting the quadriceps muscle at high frequencies. Conclusions EMS may serve as a complementary intervention to attenuate quadriceps muscle thickness loss and improve early mobilisation after MAS, supporting key principles of Enhanced Recovery After Surgery (ERAS) pathways. However, it did not improve muscle strength, muscle architecture, activities of daily living, or hospitalisation duration in the early postoperative phase. Given the moderate to very low certainty of the evidence, the findings should be interpreted with caution. With the accumulation of high-quality evidence, EMS may be considered for inclusion as a component of ERAS-based perioperative care. Trial registration CRD42024616620