Editorials

Prehabilitation: preparing patients for surgery

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3702 (Published 08 August 2017) Cite this as: BMJ 2017;358:j3702
  1. Venetia Wynter-Blyth, consultant nurse,
  2. Krishna Moorthy, consultant surgeon
  1. Oesophago-gastric cancer surgery unit, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
  1. k.moorthy{at}imperial.ac.uk

Major surgery is like running a marathon—and both require training

The impact of surgery leads to significant homeostatic disturbance.1 The surgical stress response is characterised by catabolism and increased oxygen demand. The extent and duration of the stress response is proportionate to the magnitude of surgery and the associated risk of developing postoperative complications.2

Patients who experience postoperative complications within 30 days of surgery have a reduced long term survival rate.3 Even in the absence of complications there is a 20-40% reduction in postoperative physical function and a significant deterioration in quality of life after major surgery.4

The demand for surgical services is increasing as a result of an expanding, ageing population. Added to which, patients are becoming more “high risk” as they are often elderly, frail, and obese. These factors are not only associated with adverse postoperative outcomes but may negatively impact on decision making and, consequently, fair access to surgery.5

To date, efforts to improve outcomes and access have predominantly focused on improving surgical and anaesthetic techniques. Enhanced recovery protocols have contributed to early recovery, but …

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