Prehab is the new rehab! Why getting fit before an operation could speed up your recovery

Prehab is the new rehab! Why getting fit before an operation could speed up your recovery

We're getting ready for fun runs and even beach vacations, but most people do not consider the idea of ​​getting fit for an operation.

However, Ravi Mahajan, Professor of Anesthetics and Intensive Care at Nottingham University Hospital NHS Trust and President of the Royal College of Anesthetists, has a major impact on the success of the procedures and the increase in complication rates.

"Surgery can expose the body to tremendous stress by disrupting hormone levels while triggering the immune system and sympathetic nervous system," he says.

"A large number of patients underwent surgery, leading to complications that led to prolonged hospitalization or re-admission for further treatment because they were not fit, overweight or smoked.

"The physical and mental preparation in advance of surgery can ensure that the body is better equipped for these upheavals and speeds recovery."

Did you know? In England and Wales, there are around 250,000 high-risk surgeries each year - and our bodies are often not fit enough to handle the trauma efficiently

Did you know? In England and Wales, there are around 250,000 high-risk surgeries each year - and our bodies are often not fit enough to handle the trauma efficiently

Did you know? In England and Wales, there are around 250,000 high-risk surgeries each year – and our bodies are often not fit enough to handle the trauma efficiently

The Royal College of Anesthetists calls for pre-rehabilitation (or "Prehab") in the months prior to surgery, a combination of physical activity, education, and psychological support to become routine in NHS hospitals.

It has launched a toolkit called Fitter Better Sooner, which guides patients in preparing for surgery and hospitalization.

In England and Wales there are about 250,000 high-risk operations per year. The risk of complications such as respiratory arrest (where respiratory problems lead to lack of oxygen and too much carbon dioxide) is about 20 percent or pneumonia.

"Patients should be encouraged to increase their fitness and mental health prior to surgery to increase the likelihood that they will perform better and recover faster," says Professor Mahajan.

Currently, Prehab is only offered in a handful of hospitals because it is a relatively new concept – but these hospitals have already taken advantage of it. In the last two years, patients admitted to the Manchester University NHS Trust for pre-existing conditions in the field of cancer of the stomach were given surgery before their Prehab operation.

The 12-week program includes breathing exercises and physiotherapy, as well as coaching on nutrition and smoking cessation assistance.

Patients also have a 20-minute fitness test and visit the Surgery School, where they learn more about their surgery and meet the doctors and nurses who will take care of them.

Help: In the past two years, patients enrolled at Manchester University's NHS Trust for abdominal cancer surgery have received Prehab surgery

Help: In the past two years, patients enrolled at Manchester University's NHS Trust for abdominal cancer surgery have received Prehab surgery

Help: In the past two years, patients enrolled at Manchester University's NHS Trust for abdominal cancer surgery have received Prehab surgery

Data published in the Anesthesia journal last year showed that complications such as pneumonia were reduced by 50 percent and duration of hospitalization by three days among the patients involved in the program.

Patients are encouraged to continue to build their strength at home. "We give lots of tips on what to do and what to avoid," says Nikki McGill, the Trust's physiotherapist. For example, the patient is taught simple arm exercises and lunges, and must repeatedly stand up from a sitting position.

Hiking, cycling, gardening and dancing can also improve fitness before surgery.

Dr. John Moore, an intensive care and anesthesiologist who runs the Manchester study, says: "Our patients are essentially training for a" big event "(ie surgery) and should try muscle-strengthening exercises such as lifting weights 20 Minutes a day and cardiovascular exercises, such as walking or cycling three times a week for an hour. & # 39;

In another study at Royal Bournemouth Hospital, patients who had sessions with a psychologist were asked to discuss their concerns before postoperative orthopedic surgery had less pain.

"More than 150 patients undergoing hip and knee surgery have taken the therapy sessions and are discharged on average two days earlier than those who do not visit a psychologist," says Professor Mahajan. "To discuss anxiety before surgery can help patients recover."

Anyone can benefit from Prehab, even if he quits a few days before a procedure, Dr. Andrew Klein, consultant for anesthesia at the Royal Papworth Hospital in Cambridge.

If you have months or weeks, you can work on fitness and weight loss, but even in two or three days, you can improve the outcome by ensuring optimal nutrition, stopping smoking and treating problems like anemia by administering iron supplements , & # 39;

Those who take the trouble to train for their upcoming surgery may even find that they can completely avoid it. "Take the case of knee replacement surgery," Dr. Small. "Some patients who lose weight and build muscle power in their legs may not need it at all. Prehab makes sense. "

Visit the rcoa.ac.uk website for advice

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