Prehabilitation shows promise in improving health and reducing complications after surgery

A new study published in The BMJ suggests that prehabilitation (also called prehab) may reduce complications and length of hospital stay after surgery, while also improving quality of life and physical recovery.

The systematic review and meta-analysis, the largest of its kind, examined data from more than 15,000 patients enrolled in 186 randomized controlled clinical trials around the world.

The researchers looked at different types of prehab, including exercise, nutritional improvement, psychological support, cognitive training and various combinations of these. They found that exercise was the most promising component, followed by nutritional improvement.

“If you are going to have surgery, it is always a good idea to ask about prehabilitation,” says lead author Dr. Daniel McIsaac, anesthesiologist and senior scientist at The Ottawa Hospital and Clinical Research Chair in Perioperative Innovation at the University of Ottawa. .

“If you are willing and able to regularly increase your activity level and protein intake for a few weeks before surgery, you will likely experience a noticeably shorter recovery time after surgery.”

However, the researchers note that many of the prehabilitation trials were conducted in single hospitals, and therefore it is unclear how well the results would translate to other hospitals or outside tightly controlled research settings.

“Prehabilitation is promising, but we still don’t know how to best implement it in hospitals and healthcare systems,” says Dr. McIsaac.

“We are quite confident that if patients can do the work of prehabilitation, they will likely benefit from it. The big question is how can we achieve prehabilitation that works for all surgical patients at a system level? Ongoing multicenter studies should provide an outcome provide more rigorous evidence to support broader implementation.”

Fitness influences recovery

The term “prehabilitation” dates back to World War II, when the British Army used it to refer to approaches to improving the general health and fitness of military recruits. The term was later adopted by the medical community and prehab has become an important area of ​​research over the past thirty years.

“We know that people who are more physically fit recover faster from surgery and experience fewer complications,” said Dr. McIsaac.

“Although many patients, with encouragement from their physicians, want to improve their condition before surgery, patients often do not know where or how to start. The goal of our research program is to develop a simple and effective approach to prehabilitation that can benefit are the largest number of patients who meaningfully improve their surgical recovery and help patients get home faster after surgery.”

More than 300 million operations are performed worldwide every year. Unfortunately, more than 20% of patients undergoing major surgery experience postoperative complications, which can increase the length of hospital stay and delay recovery.

Major patient-led prehab studies are underway

Although most prehab clinical trials reported to date have taken place in single hospitals with small numbers of patients, The Ottawa Hospital’s Aging Innovation In Perioperative Medicine & Surgery (AIMS) Research Group is currently conducting two large multi-centre prehab trials . The first trial has enrolled patients and results are expected to be published in March 2025.

The second trial, which focuses on virtual home-based prehab, is currently registering patients across Canada who have elective surgery that requires at least one night in hospital.

Clinicians, scientists and patient partners across Canada contribute to these studies through the Canadian Prehabilitation Knowledge Network and the Canadian Perioperative Anesthesia Clinical Trials (PACT) Group. Patient engagement is prioritized at all stages to ensure results are relevant to patients and the healthcare system.

Gurlie Kidd, a retired social worker who underwent major surgery, has been a patient partner of the team since 2020. Her feedback has ensured that the patient voice is central to all prehab studies at The Ottawa Hospital.

“It’s empowering to know that you can do something to prepare for surgery that will help your recovery. Patients are hungry for this,” Kidd said. “I hope that one day prehab will be the standard of care before all major surgeries.”