Table 1

Example of how Enhanced Recovery After Surgery and prehabilitation pathways differ and could be integrated

ItemEnhanced Recovery After SurgeryPrehabilitation
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.