A new study has explored the impact of prehabilitation before surgery, and found that it can help patients to get fitter before their procedure, and stay well afterwards.
Surgery is a big life event which can prompt people to make healthy changes both before and after a procedure. 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, and if people stick to these healthy changes after their surgery, they can stay healthier in the long run.
A study led by researchers from the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) looked at the effects of pre-operative behaviour change on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults.
It found that patients who were involved in prehab were fitter before surgery and in some cases this improvement lasted up to a month after surgery. It also found that prehab helped smokers to quit before surgery and that some patients continued to not smoke for up to one year after surgery. It also found that some patients who undertook prehab left hospital up to 1.5 days sooner after surgery.
Background to the study
Prehabilitation interventions are being delivered across surgical specialities to improve health risk behaviours leading to better surgical outcomes and potentially reduce length of hospital stay. Most of the research so far has focused on specific surgery specialities and has not considered the impact of interventions on health inequalities, nor whether prehabilitation improves health behaviour risk profiles beyond surgery.
The aim of this review was to examine behavioural prehabilitation interventions across surgeries to inform policy makers and commissioners of the best available evidence.
It looked at 67 randomised controlled trials (RCTs) to determine the effect of behavioural prehabilitation interventions targeting at least one of: smoking behaviour, alcohol use, physical activity and dietary intake (including weight loss interventions) on pre- and post-surgery health behaviours, health outcomes, and health inequalities.
Key findings included:
- 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
- Prehab helped some patients leave hospital sooner after surgery (1.5 days sooner)
Dr Mackenzie Fong from Newcastle University led the study. She is a Research Associate supported by the NIHR ARC North East and North Cumbria.
She said: “This study has shown that helping patients to make healthy changes can help them have safer surgeries and recover faster, which is not only beneficial for the patient, but also helps to save the NHS money as it means that in many cases, people can leave hospital sooner after a procedure.
“We know that when someone needs surgery, it can often act as a wake-up call or ‘teachable moment’ for them in terms of their health behaviours around drinking alcohol, smoking or being very overweight. Prehabilitation can help to kick-start positive behaviour change, and if people stick to those healthy changes after surgery, they can stay healthier in the long run.”
Read the full paper: The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: A systematic review and meta-analyses, PLOS ONE, July 2023