Earlier this week, I mentioned briefly surgical “pre-hab”. And I got quite a lot of feedback in my messages.
It is not uncommon for patients, particularly those who have arthritis or back pain, to be advised by their surgeons to “go and lose some weight before we do surgery.” Which is how some of them end up referred to me.
What is surgical pre-hab? It is making sure that a patient is as healthy as possible when they go in for their surgery.
Why? The healthier a patient is before the surgery, the more likely it is that they will have a shorter hospital stay, reduces risks of complications, and less likely to need to go back to hospital again in the weeks after their surgery.
What does it involve? It depends on the patient. We usually set goals such as improving exercise tolerance (heart and lung health), mental health (reducing anxiety about upcoming surgery), and looking at nutrition (protein, in particular, can be important). Reviewing blood sugars or asthma inhalers might be needed. **If patients are smoking/vaping, it can make a big difference if they can quit before surgery, and that’s often one of the biggest things we work on!** It’s not so straightforward all the time: Patients are going for surgery because they need surgery. That means their health is impacted in some way, and likely there are significant related reasons that they actually can’t just exercise or are struggling with eating. Where needed, we involve expert allied health professionals.
The back story about why I’m so passionate about this?
When I was a surgical trainee – years ago, in my second year ever as a doc! – for a period of time, my training consultant was an internationally-renowned Professor, on the cusp of retirement. One of his eccentricities (and I mean this in all the good ways) was that his patients should have their exercise tolerance improved, if at all possible, before planned major surgeries. He gave me the job to walk some of his pre-op patients up and down the back staircase of the hospital in the days ahead of their surgery (If you are wondering: no, I did not have the time to do this added task to a surgical work-load. Not at all. Which led to another of his eccentricities: the 10.30pm ward round. Work-life balance was not a thing in my life.)
Later in my career, I covered a surgical pre-assessment clinic. However, it didn’t get patients ready or reduce risks. It was to identify the risks we should know about ahead of time. And as my career went on, I realised that, as surgeons, we were really, really good at knowing which patients were at risk for poorer outcomes. (To paraphrase the maxim, the best surgeons aren’t those who know how to operate but those who know when not to operate.) Many of my colleagues were really good at pointing risks out to patients (sometimes bluntly, occasionally in ways that were trauma-inducing). However, even among the best surgeons, few currently have the expertise, resources, or the time to intensively pre-hab patients in the weeks coming up to a planned surgery. To put it simply, there is a difference between telling a patient to quit smoking/vaping – and actually helping a patient, using evidence-based supports, to quit smoking/vaping.
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