Article Figures & Tables
Figures
- Fig. 1
As participants waited for surgery, they experienced fear, anxiety and isolation, and perceived deterioration of their mental and physical states. Actively engaging patients in the recovery process by preparing for surgery might alleviate some of the anxiety and fear associated with waiting passively for surgery.
- Fig. 2
Patients perceived that a prehabilitation program could prepare them for their operation if it focused on optimizing their mental and physical states, offered personalized support from health care professionals and peers, provided strategies to help get their home and body ready for postoperative recovery, and included surgical expectations (both what to expect and what is expected of them). ERAS = Enhanced Recovery After Surgery.
- Fig. 3
A patient-oriented preoperative program has the potential to ameliorate deterioration during the waiting period for surgery and promote a mindset to recover well. It is essential to recognize that preoperative preparation should occur on a continuum that meets patients where they are at and in a partnership that respects patients’ expertise and desired level of engagement.
Tables
- Table 1
Example of how Enhanced Recovery After Surgery and prehabilitation pathways differ and could be integrated
Item Enhanced Recovery After Surgery Prehabilitation Preoperative optimization Medical clearance for surgery
Correction of anemia
Medication management
Smoking cessation
Risk stratification and referral to prehabilitation program
Nutrition and metabolic optimization, such as personalized counselling and targeted interventions to reduce nutrition-impact symptoms (e.g., nausea) and supplementation to correct malnutrition
Physical optimization to enhance cardiorespiratory capacity, build strength, and preserve function through exercise classes or home exercise programs
Psychologic preparation and stress reduction, such as deep-breathing exercises, visualization techniques and emotional support
Preoperative patient education Surgical logistics and what patients can expect during their hospital stay
Prepare patients to partake in patient-oriented ERAS elements, including early mobilization
Answer patient questions during the education session
Explain why it is important to prepare for surgery and how to optimize nutrition, exercise and mental health before surgery
Correct misconceptions such as fad diets and that exercise must involve gym attendance
Be available to answer questions and offer regular support (e.g., telephone calls) throughout the perioperative period
Additional suggestions from patients Consider offering the preoperative ERAS education as a group class
Involve partners and caregivers
Involve peers with surgery experience
Discuss postdischarge limitations, such as weightlifting restrictions, so that patients can be prepared to recover well at home (e.g., buying groceries, and preparing and freezing meals)
Provide instructions and demonstrations so patients feel comfortable getting out of bed and coughing after surgery
Involve partners and caregivers for additional support and encouragement
Consider group classes, such as information sessions on nutrition or meditation, and exercise classes to encourage social support
Include a peer with surgery experience on the team to reinforce the benefits of nutrition, exercise and psychologic preparation, as well as augment emotional support
Focus on personal recovery goals
Listen to concerns
ERAS = Enhanced Recovery After Surgery.
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