Tailoring prehabilitation to address the multifactorial nature of functional capacity for surgery

Abstract

Mounting evidence suggests that recovery begins before the surgical incision. The presurgery phase of recovery, namely the preparation for optimal surgical recovery, can be reinforced with prehabilitation. Prehabilitation is the approach of enhancing the functional capacity of the individual to enable them to withstand a stressful event. With this narrative review, we apply the Wilson and Cleary conceptual model of patient outcomes to specify the complex and integrative relationship of health factors that limit functional capacity before surgery. To have the greatest impact on patient outcomes, prehabilitation programs require individualised and coordinated care from medical, nutritional, psychosocial and exercise services.

Nutritional risk predicts postoperative complications and length of stay, whereas sarcopenia risk predicts need for step‐down care in a mixed elective surgery population

“…The sample was heterogeneous in terms of the complexity of the surgical procedure performed as both day‐cases and nonday‐cases were included, but also in terms of the indication for surgery, with most patients undergoing surgery for benign disease. This study is set against a backdrop of mounting evidence for surgical prehabilitation − an approach where an individual's preoperative functional ability is enhanced to enable them to better withstand the metabolic stress of surgery 34 . Because patients with a malignant pathology were more likely to report unintentional weight loss than those with benign disease, and those attending for nonday‐case procedures were at greater nutritional risk than those attending for day‐case procedures, it is reasonable that future prehabilitative interventions be targeted at these patient groups.…”

Prehab to rehab: Living with and beyond cancer

“…This important paper highlights the challenges of a real‐world study where, despite systematic collection of data, almost half the patients referred for the prehabilitation programme were not screened for the risk of malnutrition. The inclusion of nutrition as part of the complex prehabilitation intervention is not universal; however, the potential of programmes to influence functional capacity requires identification of the root causes that limit function and are expertly described by Gillis et al 5 This narrative review provides a deep dive, beyond initial screening, to explore the complex interactions of modifiable factors, in a paper that provides ‘food for thought’ for clinicians and researchers alike.…”