Surgery: Moving People, Improving Outcomes
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.
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|Year and volume||2016 1|
|Key words||fysiotherapie, chirurgie|