A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation

  • Michael H.-G. LiEmail author
  • Vladimir Bolshinsky
  • Hilmy Ismail
  • Kate Burbury
  • Kwok M. Ho
  • Babak Amin
  • Alexander Heriot
  • Bernhard Riedel
Reports of Original Investigations



Preoperative fitness training has been listed as a top ten research priority in anesthesia. We aimed to capture the current practice patterns and perspectives of anesthetists and colorectal surgeons in Australia and New Zealand regarding preoperative risk stratification and prehabilitation to provide a basis for implementation research.


During 2016, we separately surveyed fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) and members of the Colorectal Society of Surgeons in Australia and New Zealand (CSSANZ). Our outcome measures investigated the responders’ demographics, practice patterns, and perspectives. Practice patterns examined preoperative assessment and prehabilitation utilizing exercise, hematinic, and nutrition optimization.


We received 155 responses from anesthetists and 71 responses from colorectal surgeons. We found that both specialty groups recognized that functional capacity was linked to postoperative outcome; however, fewer agreed that robust evidence exists for prehabilitation. Prehabilitation in routine practice remains low, with significant potential for expansion. The majority of anesthetists do not believe their patients are adequately risk stratified before surgery, and most of their colorectal colleagues are amenable to delaying surgery for at least an additional two weeks. Two-thirds of anesthetists did not use cardiopulmonary exercise testing as they lacked access. Hematinic and nutritional assessment and optimization is less frequently performed by anesthetists compared with their colorectal colleagues.


An unrecognized potential window for prehabilitation exists in the two to four weeks following cancer diagnosis. Early referral, larger multi-centre studies focusing on long-term outcomes, and further implementation research are required.

Un sondage transversal examinant les perceptions des anesthésiologistes et des chirurgiens australiens concernant la stratification préopératoire du risque et la préhabilitation



Le conditionnement physique préopératoire a été cité dans les dix priorités de recherche les plus importantes en anesthésie. Notre objectif était de déterminer quels étaient les habitudes actuelles de pratique ainsi que les perspectives des anesthésistes et des chirurgiens colorectaux en Australie et en Nouvelle-Zélande concernant la stratification préopératoire du risque et la préhabilitation afin de proposer un point de départ pour la recherche sur sa mise en œuvre.


Au cours de l’année 2016, nous avons soumis un questionnaire séparé aux membres du Collège australien et néozélandais des anesthésistes (ANZCA - Australian and New Zealand College of Anaesthetists) et aux membres de la Société colorectale des chirurgiens australiens et néozélandais (CSSANZ - Colorectal Society of Surgeons in Australia and New Zealand). Nos critères d’évaluation portaient sur les données démographiques, les habitudes de pratique et les perspectives des répondants. Les questions sur les habitudes de pratique touchaient à l’évaluation préopératoire et la préhabilitation fondée sur l’exercice physique et l’optimisation antianémique et nutritionnelle.


Nous avons reçu 155 réponses d’anesthésistes et 71 réponses de chirurgiens colorectaux. Notre questionnaire a révélé que les deux spécialités reconnaissaient que la capacité fonctionnelle est liée au pronostic postopératoire; toutefois, moins de répondants étaient d’avis qu’il existe des données probantes fiables concernant la préhabilitation. Dans la pratique de routine, la préhabilitation demeure peu courante mais a le potentiel de prendre plus d’ampleur. La plupart des anesthésistes estiment que leurs patients ne sont pas stratifiés adéquatement en fonction de leur risque avant leur chirurgie, et la plupart de leurs collègues colorectaux sont ouverts à l’idée de retarder la chirurgie d’au moins deux semaines supplémentaires. Deux tiers des anesthésiologistes n’ont pas eu recours à un test d’effort cardiopulmonaire par manque d’accès à ce type d’examen. L’évaluation et l’optimisation antianémique et nutritionnelle sont moins fréquemment réalisées par les anesthésistes comparativement à leurs collègues colorectaux.


Il existe une fenêtre potentielle mais non reconnue pour la mise en œuvre d’une préhabilitation au cours des deux à quatre semaines suivant l’annonce d’un diagnostic de cancer. Une prise en charge précoce par des spécialistes, des études multicentriques plus importantes s’intéressant aux pronostics à long terme et des travaux de recherche supplémentaires sur la mise en œuvre sont nécessaires.



We would like to thank the ANZCA CTN and the CSSANZ secretariat for vetting and facilitating the survey’s distribution. We also acknowledge Prof Linda Denehy, A/Prof Prue Cormie, Mr Satish Warrier, Ms Belinda Steer, and Ms Fiona Wiseman for feedback regarding the surveys. Dr Ho would like to thank WA Health and Raine Medical Research Foundation for their support through the Raine Clinical Research Fellowship.

Conflict of interest

Dr. Ho is funded by WA Health and Raine Medical Research Foundation through the Raine Clinical Research Fellowship. The funding agencies have no influence on the choice of the subject matter, design of the study, data analyses, the decision to publish the results, and the final content of the manuscript. The other authors have not received any funding.

Author contributions

Michael H.-G. Li and Vladimir Bolshinsky contributed substantially to all aspects of this manuscript, including conception and design; acquisition, analysis, and interpretation of data, and drafting the article. Kate Burbury, Hilmy Ismail, Alexander Heriot, and Bernhard Riedel contributed substantially to the conception and design of the manuscript, and drafting the article. Babak Amin contributed substantially to the analysis of data and drafting of the article. Kwok M. Ho contributed substantially to the analysis of data, interpretation of data, and drafting the article.

Editorial responsibility

This submission was handled by Dr. Gregory L. Bryson, Deputy Editor-in-Chief, Canadian Journal of Anesthesia.


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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of Cancer Anaesthesia, Perioperative and Pain MedicinePeter MacCallum Cancer CentreMelbourneAustralia
  2. 2.Department of Cancer SurgeryPeter MacCallum Cancer CentreMelbourneAustralia
  3. 3.Department of HaematologyPeter MacCallum Cancer CentreMelbourneAustralia
  4. 4.Department of SurgeryUniversity of MelbourneMelbourneAustralia
  5. 5.School of Population HealthUniversity of Western AustraliaPerthAustralia
  6. 6.School of Veterinary and Life SciencesMurdoch UniversityPerthAustralia
  7. 7.Department of Intensive Care MedicineRoyal Perth HospitalPerthAustralia

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