Please take a minute to watch the video above. Here, Dr John Whittle from University College Hospital London introduces the concept of prehabilitation and getting high-risk patients ready for major surgery.

Prehabilitation (prehab) means getting ready for surgery, using whatever time the patient has before admission. As part of the ERAS philosophy, patient mental and physical optimisation should begin as early as possible before surgery to allow optimal fitness and mental wellbeing. A prehabilitation programme provides an opportunity to discuss:

• Diet: Some patients may be malnourished and need supplementation, others seriously need to consider weight loss strategies.
• Physical activity or exercise: Most benefit from improving their physical fitness pre-operatively.
• Mental wellbeing: Prehabilitation gives an opportunity for psychological support and counselling which covers what to expect from surgery and the patient’s own involvement in prehabilitation and rehabilitation.
• Stopping smoking and reducing alcohol consumption: Prehabilitation can be seen as a positive life enhancing activity, not just preparation for surgery.

The extent and methods of delivering prehabilitation vary considerably. In an ideal world, patients should start getting themselves optimised as soon as major surgery is considered with the engagement of a multidisciplinary team, using methods tailored to each individual situation. In some larger surgical centres, this is starting to become a reality, but it is a relatively new and exciting development.

Surgery School

Local or virtual group session for patients and families.

Surgery School

As part of the learning process and psychological preparation for surgery, many patients and families attend group sessions to understand the surgical journey, their own personal role in their recovery and what to expect. At University College Hospital in London, ‘surgery school’ is seen as an opportunity for staff to talk to patients and for patients to visit POCU and become familiar with their surroundings.

Lifestyle discussions

Lifestyle discussions might happen in pre-operative assessment with the nurses or anaesthetists, by cancer nurse specialists, or by other healthcare professionals through the patient journey. Importantly, patients might meet other patients in a similar situation to themselves and it can be a very positive experience for those patients who feel they are facing their illness alone.

Those of you around in the 1980’s and watching the morning breakfast show on GMTV will remember Mr Motivator and his early morning exercise routines. Pictured below in Cardiff in 2022, this time reminding a medical audience about the importance of prehabilitation in the patient journey!

Mr Motivator in Cardiff at the WPOMS Conference 2022. (Photo credit: Ellie Powell)

Intra-operative Care

Team huddle in the immediate pre-operative phase. (Photo credit: Louise Allen Photography)

Postoperative Care

Reducing risks for surgical patients here means high quality, multidisciplinary handover of care, use of standardised guidelines and a clear understanding of the patients post-surgical needs and where best those needs will be met. Sound familiar? We are talking about POCU.

So, where should patients be cared for after surgery?

Well, we introduced the debate earlier – it’s dependent on a number of things. We said, in part, it was reliant on individual hospital set up, and what types of surgeries are performed there. They might include the situations below:

Use the discussion box below to share your experiences of enhanced recovery. Is this a concept you were aware of before this course?