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Prehabilitation

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Enhanced Recovery After Surgery

Abstract

Surgery is a stressful event. While efforts have been made to improve the intraoperative and immediate postoperative outcome with many ERAS evidence-based elements, little attention has been paid to the preoperative optimization, in particular the patient’s health status. Poor physical fitness has been associated with poor perioperative outcome, even when efforts have been made to optimize pharmacological and clinical conditions. To this extent, the preoperative period can be a salient time to intervene. Prehabilitation is the term that describes a program of optimization of functional capacity through exercise, nutrition, and coping strategies. The intent of this program, which has to be started before surgery, is to minimize the effect of surgical stress and metabolic deconditioning and to accelerate the return to baseline levels of functional capacity. Prehabilitation involves a preliminary screening and assessment of the patient’s physical, nutritional, and psychological qualities, followed by a structured and personalized multidisciplinary program started at least 4–5 weeks before surgery and to be continued after surgery if further impairments (e.g., chemotherapy) occur. The elderly, frail, and compromised patients need particular attention and can benefit most. The prehabilitation program in preparation for surgery can be housed in the preoperative clinic and requires the collaboration of surgeons, anesthesiologists, internists, family doctors, nurses, physiotherapists, nutritionists, kinesiologists, and psychologists.

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Authors and Affiliations

  1. Peri-Operative Program, Montreal General Hospital, McGill University, Montreal, QC, Canada

    Enrico M. Minnella & Chelsia Gillis

  2. Brock University, St. Catharines, ON, Canada

    Linda Edgar

  3. McGill University School of Nursing, Peri-Operative Program, Montreal General Hospital, Montreal, QC, Canada

    Linda Edgar

  4. Department of Anesthesia, McGill University, Montreal, QC, Canada

    Francesco Carli

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  1. Enrico M. Minnella
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  2. Chelsia Gillis
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  3. Linda Edgar
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  4. Francesco Carli
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Correspondence to Francesco Carli .

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Editors and Affiliations

  1. Department of Surgery, Örebro University Hospital, Örebro, Sweden

    Olle Ljungqvist

  2. Yeovil District Hospital NHS Foundation Trust Higher Kingston, Yeovil, Somerset, UK

    Nader K. Francis

  3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s, Hospital Harvard Medical School, Boston, MA, USA

    Richard D. Urman

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Minnella, E.M., Gillis, C., Edgar, L., Carli, F. (2020). Prehabilitation. In: Ljungqvist, O., Francis, N., Urman, R. (eds) Enhanced Recovery After Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-33443-7_10

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