Surgery: Moving People, Improving Outcomes

Surgery aims to improve a patient’s medical condition. \nHowever, surgery is a major life event with the risk \nof negative consequences, like peri- and postoperative \ncomplications, prolonged hospitalization and delayed recovery \nof physical functioning. One of the major common \nside effects, functional decline, before (in the “waiting” \nperiod), during and after hospitalization is impressive, especially \nin frail people. \nPreoperative screening aims to identify frail, highrisk \npatients at an early stage, and advice these high-risk \npatients to start supervised preoperative home-based exercise \ntraining (prehabilitation) as soon as possible. Depending \non the health status of the patient and his/her \noutcomes during the screening and the type of surgery, \nprehabilitation should focus on respiratory, cardiovascular \nand/or musculoskeletal parameters to prepare the patient \nfor surgery. By improving preoperative physical fitness, \na patient is able to better with stand the impact of \nmajor surgery and this will lead to a both reduced risk of \nnegative side effects and better short term outcomes as a \nresult. Besides prehabilitation hospital culture and infrastructure \nshould be inherently activating so that patients \nstay as active as can be, socially, mentally and physically. \nIn the first part of this chapter the concept of prehabilitation \nand different parameters that should be trained \nwill be described. The second part focuses on the “Better \nin, Better out” (BiBo™) strategy, which aims to optimize \npatient’s pre-, peri- and postoperative physical fitness. \nPrehabilitation should comprise “shared decisions” between \npatient and physical therapist regarding experience \nand evidence based best options for rehabilitation goals, \nneeds, and potential of the individual patient and his/her \n(in) formal support-system. Next, a case will describe the \npreoperative care pathway. This chapter will close with \nconclusions about how moving people before and after \nsurgery will improve their outcomes.