Whether you’re in the “couch-to-5k” bracket or preparing for a marathon, no one expects you to be able to comfortably complete a physically demanding running event without training beforehand. .
The same mindset for building fitness is being promoted among people awaiting surgery in the evolving health field of “pre-rehabilitation.” The healthier the patient goes to the operating room, the more likely they are to get through the surgery without complications and the faster they are likely to recover.
But among some patients facing major surgery, there is a tendency to think they should sit down, rest and conserve energy for what’s to come, says General Consultant and Colorectal Surgeon at Tallaght University Hospital suggests Maria Whelan. On the other hand, what you need to do is actively work on increasing your body’s reserves.
Everyone is familiar with the concept of post-surgical rehabilitation, and when expert surgical dietitian Siobhan Power first presented the idea of a pre-rehabilitation initiative to colleagues at Tallaght hospital, “everyone was shocked by her I thought the title was misspelled,” Whelan laughs. This is an area of particular interest to Power. He surveyed patients who had undergone major surgery involving the gastrointestinal tract and received feedback that he felt underprepared and wanted more information about what he could have done to improve it. I got it.
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Power, in partnership with Whelan and in consultation with a multidisciplinary group of medical colleagues and the hospital’s communications team, has facilitated the production of a series of animated videos titled “Stronger for Surgery,” scheduled to be released this week. is.
These provide simple guidance to patients on four important aspects of preparing for surgery.
- exercise
- nutrition
- anxiety and mental health
- no smoking
It’s about being the best you personally can be, regardless of your age or health status.
“Surgery causes tissue destruction, so when you do something like that to your body, your body has to heal it,” Whelan says. The body must use all of its resources to repair or grow new parts. “You’re going to use a lot of energy to do that. If you don’t have muscle mass, that’s a problem.”
For those undergoing emergency surgery, pre-rehabilitation is not an option, but for those awaiting elective surgery, it is a part of their treatment that they can control. Instead of viewing being on the waiting list as a time spent passively waiting for a phone call, she suggests viewing it as an opportunity to prepare.
“Very few people are as healthy as they should be, so everyone is living with some sort of challenge, whether it’s physical fitness, weight, or smoking,” says Whelan. However, patients may not know that there are things they can do to improve their health and that undergoing the surgical process does not guarantee certain results.
There are currently 140,000 people on waiting lists for hospitalization or day surgery across the Republic. Mr Power said anyone undergoing any type of surgery could benefit from some aspects of the Stronger for Surgery series, which is available on Tallaght Hospital’s website (tuh.ie) and its Anyone can watch it through his YouTube channel. Taller’s own patients will see his QR code for a video included in a letter about their scheduled surgery.
“The benefit of these videos is that they can be accessed anytime, anywhere, on any electronic device, and shared with family and carers,” says Power, who hopes GPs will start referring patients to this resource. . It is funded by seed funding from the HSE’s innovation program Spark Ignite.
This is a way to let patients know that there are things they can do and control, “rather than seeming like everything is happening to you or being done to you,” Whelan says. “We’re not trying to burden patients, we’re trying to support them.”
On the food and nutrition front, “we really want to avoid frailty and malnutrition,” Power says. “Believe it or not, these are very common problems.
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“Sometimes I see patients who come in for surgery knowing inherently that they would have benefited from more tailored advice before surgery. Proteins play a role in wound healing and building the immune response. It’s probably an important nutrient for people preparing for surgery.”
Professor Power published a research paper examining nutrition, frailty and stress scores in 100 patients undergoing surgery at Tara University Hospital.
“We found that patients who were at nutritional risk developed more postoperative complications.” Patients with sarcopenia, or at risk of losing muscle mass, have sufficient muscle reserves. They were more likely to require a convalescent period compared to patients.
“What we’re trying to mitigate are modifiable risk factors,” Whelan said.
The hospital does not have a structured rehabilitation program, and she and Power hope this is the first step. This is not something that needs to be done within a hospital, so they are looking at the possibility of such a program being run through community partners.
Currently, pre-rehabilitation advice is provided on an ad hoc and individual basis. “We may identify someone who we think is at significant risk pre-operatively, so we will ask Siobhan to meet them,” Mr Whelan said. “They would obviously be in danger if I triggered it.
“We admit some patients because we know they need volume up front and it’s actually dangerous to do surgery in their current condition.” Life expectancy As the number of people living with the disease increases, more people are undergoing surgery at an older age.
“We’re operating on people who we wouldn’t have operated on 20 years ago when I started practicing medicine,” says Whelan. “Age is just a number. I never think that someone can’t have something just because they’re 80 years old. It really depends on their functional status. They can’t use a lawn mower at home and go out. If they shop and take their purchases home, even if they’re 84 years old, that’s a good sign that they’ll go through with the surgery, even if it’s difficult.”
“That’s why we want to use the video to remind people not to be sedentary and not to be afraid just because surgery is being done,” Power said. We want people to stay active right up to surgery. ”
St James’s Hospital in Dublin was the first hospital to introduce a physiotherapy-led pre-operative program specifically for patients undergoing cancer surgery. Piloted in 2018 and rolled out in 2019, the program targets thoracic, upper gastrointestinal, colorectal, head and neck, gynecological, breast and urinary cancers. The focus is on the patient. The surgical team will refer the patient to physical therapy for an online or in-person assessment, and then they will be invited to participate again in-person or remotely in an exercise program that focuses on both aerobic and strengthening exercises. . This program continues until the patient’s surgery date.
The exercise program was only available in-person until the coronavirus pandemic, after which it was forced to switch to a fully virtual service. It is run by clinical specialist physiotherapist Sarah Wade, who recently completed her master’s degree at the University of Ulster and researched patient satisfaction and virtual health experiences.
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“Following her findings, the decision was made to implement a hybrid program that will continue to offer online options to patients living outside of Dublin,” a hospital spokesperson explained. The number of patients participating in this exercise-based pre-rehabilitation has increased every year since its introduction, with 802 people participating in 2023.
Feedback from patients has been very positive, a spokesperson said, sharing patient testimonials such as: Wow, that’s very nice. You will truly understand how to progress in your recovery without having to look for drugs. ”
Clinical nutrition and speech therapy is provided to patients awaiting surgery for head and neck cancer. Cancer patients can also be referred to the hospital’s psycho-oncology service before surgery. A spokesperson said St. James’s recently began offering “preoperative exercise intervention for patients awaiting stem cell transplants.”
The similarities between preparing for surgery and training for an athletic competition are highlighted by a recent international study involving University of Limerick (UL) researchers into the effects of simulated altitude on elderly patients at risk of surgery-related health complications. is supported by. Lower oxygen levels at high altitudes are known to stimulate an increase in hemoglobin in the blood to carry more oxygen throughout the body.
Eight sedentary volunteers, with an average age of 64, lived for two weeks at UL’s National High Altitude Training Center, where oxygen levels could be tightly controlled in each room. For a week there was an air of normalcy in the house. During the second week, oxygen levels dropped slightly to the levels he would experience at 2,438 meters (8,000 feet). Volunteers underwent cardiopulmonary exercise tests before and after the one-week exposure.
The study, published last December in the journal Anesthesiology, found that simulated high altitude stimulated a significant increase in hemoglobin in participants, but no significant changes in aerobic fitness. However, this increase in hemoglobin may be clinically beneficial prior to surgery. This could be produced by providing a small hypoxic canopy that the patient can use while sleeping in the weeks leading up to surgery.
“It’s more like an exercise drug,” says Professor Phil Jakeman, professor of sport and exercise science at UL. Exposure to reduced oxygen levels triggers a physiological response that could be a way for patients who are unable to exercise to slightly improve their bodies’ ability to protect themselves from the trauma of surgery. The study also shows that “starting from a low base, less ‘fit’ individuals can increase hemoglobin to a greater extent than elite athletes.”
Meanwhile, at Tallaght Hospital, Mr Whelan and Mr Power are keen to raise awareness among both the public and professionals about the possibilities of rehabilitation. The former states that there is no doubt that there will be rehabilitation specialists in the future, just as there are rehabilitation specialists in the medical service.
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