Multi‐modal prehabilitation: addressing the why, when, what, how, who and where next?

Scheede‐Bergdahl, Celena; Minnella, Enrico Maria; Carli, Francesco

doi:10.1111/anae.14505

Cited by 140 publications

(94 citation statements)

References 42 publications

(44 reference statements)

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“…Such interventions also offer a psychological boost at a time when patients may feel very limited control of their immediate destiny. Smoking cessation , alcohol cessation , nutritional optimisation and physical activity and exercise are covered in detail elsewhere in this supplement . In each case, despite the current very limited evidence base, there are data available to point to the likelihood of significant clinical benefit in terms of improvements in short‐term clinical outcomes.…”

Section: Peri‐operative Care Pathwaysmentioning

confidence: 99%

Peri‐operative care pathways: re‐engineering care to achieve the ‘triple aim’

et al. 2019

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Elective surgical pathways offer a particular opportunity to plan radical change in the way care is delivered, based on patient need rather than provider convenience. Peri-operative pathway redesign enables improved patient experience of care (including quality and satisfaction), population/public health, and healthcare value (outcome per unit of currency). Among physicians with the skills to work within peri-operative medicine, anaesthetists are well positioned to lead the re-engineering of such pathways. Re-engineered pre-operative pathways open up opportunities for intervention before surgery including shared decision-making, comorbidity management and collaborative behavioural change. Individualised, risk-adapted, intra-operative interventions will drive more reliable and consistent care. Risk-adapted postoperative care, particularly around transitions of care, has a significant role in improving value through peri-operative medicine. Improved integration with primary care providers offers the potential for minimising errors around transitions of care before and after surgery, as well as maximising opportunities for population health interventions, including lifestyle modification (e.g. activity/exercise, smoking and/or alcohol cessation), pain management and sleep medicine. Systematic data collection focused on quality improvement is essential to drive continuous clinical improvement and will be enabled by technological development in predictive analytics, systems modelling and artificial intelligence.

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Section: Peri‐operative Care Pathwaysmentioning

confidence: 99%

Peri‐operative care pathways: re‐engineering care to achieve the ‘triple aim’

et al. 2019

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“…Several risk behaviours are implicated in the development of pathologies that require major surgical intervention. Prevalence may be higher in surgical populations . However, targeting risk behaviours before surgery may provide particular opportunities.…”

Section: Introductionmentioning

confidence: 99%

Exploring patient attitudes to behaviour change before surgery to reduce peri‐operative risk: preferences for short‐ vs. long‐term behaviour change

et al. 2019

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Pre-operative intervention to improve general health and readiness for surgery is known as prehabilitation. Modification of risk factors such as physical inactivity, smoking, hazardous alcohol consumption and an unhealthy weight can reduce the risk of peri-operative morbidity and improve patient outcomes. Interventions may need to target multiple risk behaviours. The acceptability to patients is unclear. We explored motivation, confidence and priority for changing health behaviours before surgery for short-term peri-operative health benefits in comparison with long-term general health benefits. A total of 299 participants at three UK hospital Trusts completed a structured questionnaire. We analysed participant baseline characteristics and risk behaviour profiles using independent sample t-tests and odds ratios. Ratings of motivation, confidence and priority were analysed using paired sample t-tests. We identified a substantial prevalence of risk behaviours in this surgical population, and clustering of multiple behaviours in 42.1% of participants. Levels of motivation, confidence and priority for increasing physical activity, weight management and reducing alcohol consumption were higher for peri-operative vs. longer term benefits. There was no difference for smoking cessation, and participants reported lower confidence for achieving this compared with other behaviours. Participants were also more confident than motivated in reducing their alcohol consumption pre-operatively. Overall, confidence ratings were lower than motivation levels in both the short-and long-term. This study identifies both substantial patient desire to modify behaviours for peri-operative benefit and the need for structured pre-operative support. These results provide objective evidence in support of a 'pre-operative teachable moment', and of patients' desire to change behaviours for health benefits in the short term.

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“…Pre‐operative optimisation of the high‐risk elective surgical patient includes both lifestyle modification and medical optimisation of comorbidity. Prehabilitation is the term adopted by the McGill group to describe the identification of impairments of the patient who is being considered for major surgery, and then provide interventions that promote physical, metabolic and psychological health to reduce the incidence and/or severity of these impairments . Prehabilitation has until recently only included physical fitness training, improving nutritional status and psychological robustness.…”

mentioning

confidence: 99%

“…The time before surgery is seen as a ‘teachable moment’ , as patients are more amenable to lifestyle modifications if they can see and gain the immediate benefit of their lifestyle changes. This supplement therefore has contributions covering multi‐modal prehabilitation; as well as pre‐operative optimisation of physical, respiratory function, nutritional, and psychological status .…”

mentioning

confidence: 99%