'Prehab' before surgery means less time in hospital, better patient outcomes, P.E.I. researcher says
Doctor cites 'really meaningful improvements in quality of life'
Getting better quickly after a surgery isn't just a matter of how well the procedure went. New research shows that patients, especially older adults, can significantly improve their recovery by preparing for surgery in advance.
This approach is called prehabilitation, or prehab — a program that includes exercise, better nutrition, psychological support, and cognitive training to help position patients to recover faster.
Dr. Daniel McIsaac, originally from Mermaid, P.E.I., is among the people leading a systematic review of prehab published last month. He works in the departments of anesthesiology and pain medicine at Ottawa Hospital.
For the review, McIsaac and his co-authors at Ottawa Hospital Research Institute, McGill University in Montreal and St. Michael's Hospital in Toronto analyzed data from 15,000 patients receiving planned surgeries, as opposed to operations needed on an emergency basis.
They have noticed many benefits for patients who participate in prehab programs, the University of Ottawa professor said.
"We're seeing people get out of hospital a day or two sooner, which is a pretty big impact, if you think about the number of surgeries and patients going through hospitals," he told CBC's Island Morning.
"Once people are getting home, they're having a better ability to walk and get around and be independent at home, and whenever we ask them about their overall quality of life, they're having really meaningful improvements in quality of life as well."
Why it matters
McIsaac said his interest in prehab comes from his experience as an anesthesiologist; he has seen many patients, especially older ones, struggle to recover from major surgery. He wanted to understand how more people could have successful outcomes.
Preparing for surgery starts with the most important decision, he said: whether or not to proceed with the operation. He stressed the need for a thorough discussion with a surgeon about the potential benefits, risks and alternatives, calling that especially crucial for older patients with multiple health conditions.
For those who choose to go ahead, the real work of prehab begins.
While it seems like common sense that exercising and eating better before an operation will help, McIsaac said the stress of preparing for surgery – including attending appointments, undergoing tests and dealing with anxiety – often makes it hard for patients to change their habits on their own.
That's where structured prehab programs come in.
"How do we get them to start exercising and keep exercising when they haven't been already? How do we get them to change their diet and get a lot more protein into it?" he said.
"People need help to make these big changes as they get ready for surgery during that stressful time."
McIsaac said successful prehab usually requires at least three to four weeks. Given current wait times for surgery, this actually presents an opportunity for patients to engage in prehab, he added.
Integrating prehab into health-care system
McIsaac hopes prehabilitation can one day become a standard part of the health-care system.
Ideally, as soon as patients decide to have surgery and leave the surgeon's office, they would receive information about prehab and get enrolled in a program, he said.
"Once they're in that program, they're going to need support on a fairly regular basis to check in and make sure that they're doing their exercises… Some people may need to get sent into a gym for support. Some people can do that from home," he said.
"The other thing is just the nutrition, making sure they're getting about a gram to a gram and a half of protein per kilogram of body weight a day. That way, their body is going to be better set to heal after the big surgery that they're going to have."
McIsaac and his team are conducting large-scale, randomized trials across Canada to further explore the impact of prehab.
Their goal is to present this data to health ministers and hospital leaders to advocate for integrating prehab into standard surgical care.
With files from Island Morning