Preadaptation would promote the success of surgery, according to a study

(Montreal) Patients preparing to undergo surgery can maximize their chance of a trouble-free operation and rapid recovery if they take charge of themselves before going under the knife, a systematic review says.

Exercise tops the list of things patients can do to prepare for their surgery, followed by improving their diet.

“When we talk about surgery, we know when and why the patient is going to go to the hospital,” recalled the lead author of the study, Dr. Daniel McIsaac, anesthesiologist and senior scientist at the Ottawa Hospital. and holder of the clinical research chair in perioperative innovation at the University of Ottawa.

This systematic review covered almost 200 randomized controlled studies involving some 15,000 patients.

The authors report “finding consistent directional evidence” that exercise or nutrition-based prehabilitation interventions – or multicomponent interventions that include exercise – “can significantly reduce complication rates and length of stay” for adults preparing for major surgery, while improving their quality of life and physical recovery.

Prehabilitation, for example, reduced the risk of complications by 40% and shaved about a day off patients’ hospital stays, compared to those who received usual care.

In a context of chronic shortage of resources and beds, a shortened hospitalization, even if only for a single day, represents “a great advantage for the patient and for the health system”, underlined Doctor McIsaac.

Researchers caution, however, that prehabilitation is “a complex intervention that typically consists of multiple components”; which requires a substantial change in behavior on the part of participants; which draws on the expertise of the staff responsible for implementing the program; and which requires the development of skills on the part of the participants.

We also need to continue work to determine which prehabilitation interventions are most appropriate before each surgery, admitted Dr. McIsaac, who is currently recruiting participants to continue to explore the subject in greater depth.

“Doing more cardio, doing more strength training and eating a lot of protein will be beneficial for any type of surgery,” he said. But of course, if a patient is preparing for lung surgery, doing breathing exercises would probably make more sense. But if we think about a patient who is going to have a knee replacement, maybe do more exercises that will improve the strength of their legs. »

Most existing prehabilitation programs are offered in hospitals, which involves multiple trips each week for patients. We now have to figure out how to make them accessible to those who are not able to get there, said Dr. McIsaac.

And as is almost always the case with good lifestyle habits, it is never too late to do the right thing, recalls Dr. McIsaac, even if on this subject too, several questions remain.

When it comes to nutrition, he said, probably a week or two before surgery is enough to see benefits. When it comes to physical activity, we probably need three or four weeks.

“When we talk to patients who are participating in a prehabilitation program for their surgery, we see that they are motivated because they are doing something to improve the outcome of their surgery,” said Dr. McIsaac. We hope that the data from our study will motivate patients to change their behaviors before their surgery to obtain better results. »

More than 300 million surgeries are performed worldwide each year. Unfortunately, more than 20% of patients who undergo major surgery experience postoperative complications, which can prolong their hospital stay and delay their recovery.

The findings of this study were published by the medical journal BMJ.