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Does supporting patients to make healthy changes before surgery help them cope with their operation better, and do these healthy changes last?

Does supporting patients to make healthy changes before surgery help them cope with their operation better, and do these healthy changes last?

Quick-read summary

Surgery is a big life event which can prompt people to make healthy changes. While people wait for surgery, they may take part in prehabilitation (prehab) which helps them to make healthy changes – such as eating better, exercising more, losing weight, quitting smoking, or drinking less. This can help patients have safer surgeries and recover faster. If people stick to these healthy changes after their surgery, they can stay healthier in the long run.

In this study, we found that prehab helped patients get fitter before surgery and this lasted up to a month after surgery. Prehab helped patients quit smoking before surgery and they continued to not smoke for up to one year after surgery. Patients who did prehab left hospital sooner after surgery, but this was mostly just patients who had surgery for lung cancer.

Not many studies looked at whether patients stuck to the healthy changes long after surgery. Not many studies looked at prehab that helped people to eat better, lose weight or drink less. No studies explored for which groups of people prehab worked better and worse. For many studies, it was hard to tell what prehab involved. These things should be considered in future studies.

Who is this evidence useful for?

Healthcare commissioners who are involved in procuring perioperative services. Clinicians and professionals who are involved in delivering perioperative services e.g., anaesthetists, nurses, surgeons.

What is the issue?

  • Surgery is a big life event (a ‘teachable moment’) which can prompt people to make healthy changes
  • While patients wait for surgery, they can take part in prehabilitation (prehab) which helps them to make healthy changes to their diet, exercise, weight, smoking and drinking
  • If patients stick to these healthy changes after surgery, patients can stay healthier in the long run
  • We do not know if prehab that helps people to make these healthy changes can help patients have safer surgeries and recover faster
  • We do not know if people stick to these healthy changes after surgery
  • We do not know for what groups of people prehab works better and worse

Research summary

We found all the studies comparing people waiting for surgery who did prehab that helped them to make healthy changes, to patients waiting for surgery that did not do prehab. We found 67 studies; three-quarters of these studies focused on helping patients to make one healthy change and this was usually exercising more.

What the research found

  • Prehab helped some patients leave hospital sooner after surgery (1.5 days sooner)
  • Prehab helped patients get fitter before their surgery and up to a month after surgery
  • Prehab helped patients quit smoking before surgery and continue to not smoke up to a year after surgery – which suggests that the surgical encounter holds promise as a ‘teachable moment’ for longer-term change
  • Not many studies looked at helping people to eat better, lose weight or drink less
  • Not many studies looked at whether patients stick to the healthy changes after surgery
  • No studies explored for which groups prehab works better and worse

Why is this important?

  • Helping patients to make healthy changes can help them have safer surgeries and recover faster
  • Helping people to have safer surgeries and recover faster saves the NHS money
  • Helping people leave hospital sooner after surgery frees up hospital beds for other patients so more surgeries can be done
  • If people stick to healthy changes after surgery, they can stay healthier in the long run
  • As many people have surgery, prehab could help improve population health and this would save the NHS money

Get in touch about this research

Dr Mackenzie Fong, Research Fellow in Prevention, Early Intervention and Behaviour Change, NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC)

[email protected]

Twitter: @mcknz_fong

Link to full study paper

This work was published in PLOS ONE, July 2023

Read the full paper

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