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Perioperative Medicine – Current Controversies pp 15–47Cite as

Prehabilitation

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Abstract

Despite advances in surgical care over recent decades, major surgery still carries a significant burden of morbidity. Perioperative research and improvement strategies have classically focused on the intraoperative and postoperative phase of the surgical journey. Prehabilitation describes the concept of optimizing postoperative outcome through preoperative intervention. There are many potential targets for prehabilitation ranging from the identification and management of abnormal preoperative test results, through optimising functional status using exercise programmes, to psychological interventions addressing unhealthy behaviours known to impact on postoperative outcome.

The preoperative assessment of surgical patients has, to date, focused on ‘single organ pathology’- the detection and management of ischaemic heart disease or chronic obstructive pulmonary disease for instance. Whilst the preoperative optimisation of these comorbidities is of the utmost importance, recent evidence has emerged highlighting the detrimental impact of other, previously neglected, factors that are prevalent at significant levels in the surgical population. These factors include a variety of habitual activities such as smoking, hazardous alcohol intake, obesity and sedentary behaviour as well as comorbid states over which an individual may have less control- malnutrition, anaemia, frailty and cognitive dysfunction.

In this chapter the prevalence, relevance and impact of these factors on postoperative outcomes are presented. Potential prehabilitation strategies to address and optimize patient outcomes are described.

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Abbreviations

AUDIT-C:

The Alcohol Use Disorders Identification Test

RCT:

Randomised Controlled Trial

NNT:

Number Needed to Treat

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Authors and Affiliations

  1. Northern School of Anaesthesia and Intensive Care Medicine, Newcastle, UK

    James Durrand & Rhiannon Hackett

  2. Anaesthesia and Critical Care, York Teaching Hospitals NHS Foundation Trust, York, UK

    David Yates

  3. Department of Anaesthesia, South Tees Hospitals NHS Foundation trust, Middlesbrough, UK

    Gerard Danjoux

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  1. James Durrand
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  2. Rhiannon Hackett
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  3. David Yates
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  4. Gerard Danjoux
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Corresponding author

Correspondence to Gerard Danjoux .

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Editors and Affiliations

  1. Waimairi Anaesthesia Ltd, Christchurch, New Zealand

    Karen Stuart-Smith

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Durrand, J., Hackett, R., Yates, D., Danjoux, G. (2016). Prehabilitation. In: Stuart-Smith, K. (eds) Perioperative Medicine – Current Controversies. Springer, Cham. https://doi.org/10.1007/978-3-319-28821-5_2

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