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