
Led by the Central Adelaide Local Health Network, this projects aims to lessen the risk of preventable surgical complications and improve the recovery and health of patients undergoing planned surgery.
Is Community-based Prehabilitation Feasible and Does it Improve Elective Surgery Outcomes?
Surgery is an important part of healthcare, with over 2.5 million operations performed each year in Australia alone. However, one in five patients experience a complication after surgery, which significantly impacts patient health, leads to longer hospital stays and a higher chance of being readmitted to hospital. Many of these risks can be greatly reduced, if not completely prevented by getting as healthy as possible before surgery – a concept known as Prehabilitation (PreHab).
Health Translation SA’s is partnering with CALHN to help facilitate this exciting project led by Prof Jane Andrews. Together we are working with consumers, primary care and hospital providers to design and pilot a PreHab program for patients awaiting non-urgent elective surgery.
Background Information
Surgery is a critical component of healthcare systems. One third of the global disease burden, and two-thirds of cancers and injuries are managed by surgery. This equates to approximately 2.5 million surgical procedures per year in Australia alone. However, post-operative complications are major but under-recognised cause of morbidity and mortality in patients undergoing surgery. Approximately 20% of these patients experience post-operative complications and death within 30 days of surgery ranks as the 3rd leading cause of death worldwide. Post-operative complications directly affect patients, increase length of hospital stay, rates of avoidable re-admissions, and direct health system costs. Such complications are predicted to increase 10% annually in Australia if changes to current practice are not made. In fact, the term “the hidden pandemic” has been recently used to describe the predicted scenario where life-improving and life-saving surgery will be less safe, or unaffordable, or both without addressing these issues now.
The risk of many post-operative complications can be greatly reduced, via a variety of management and treatment options optimising preparation for surgery.
Optimal surgical care starts well before the operation. It includes choosing wisely when to operate, in whom to operate and determining whether any factors can be optimised before operation. In the elective surgery space, the first two aspects usually receive due consideration. However, current systems do not routinely ensure preoperative optimisation occurs. Currently, any pre-operative optimisation occurs via a specialised preoperative anaesthetic clinic (when it does occur) within 1-2 weeks of surgery. Whilst there is some value in this, many aspects of optimisation need to be identified and addressed over a longer time period. For example, smoking cessation is best 4 or more weeks prior to surgery and more weight loss is likely to be achieved over a longer period. This need to push back preoperative surgical optimisation timelines has led us to propose that “PreHabilitation” or PreHab (getting healthy before surgery) should commence at the time of referral for consideration of non-emergency elective surgery so optimisation(s) can commence earlier.
Perioperative timeline. Adapted from ANZCA (2019)
While previous studies have proven value in single preoperative interventions, such as smoking cessation, no-one has reported on the feasibility, acceptability and outcomes of a global PreHab approach. In this study we will codesign and pilot test a community-based prehabilitation program for patients referred for elective (planned) surgery.
This is a novel, pragmatic approach if successful, is highly likely to yield significant health gains not only to people undergoing surgery, but also to others in whom surgery may no longer be needed due to PreHab and also to others reaping the benefits of a heightened GP and community awareness of health maintenance issues and resources.
- From a system basis, this will reduce overall length of stay, via reduced complications. This will improve care costs and access to care as more cases can be done in the same bed base. Patients are also likely to have better individual outcomes from their surgery and from durable changes to lifestyle factors. Only a small engagement in such a program will yield measurable system level benefits.
- From a consumer viewpoint, this program will directly empower potential patients to take agency for their own health outcomes. It will support them to access care they need but may not be receiving in the community care setting while awaiting outpatient review. It will make their waiting time active rather than passive, improve their health literacy and make them real partners in their healthcare provision.
Project Steering Committee
Prof Jane Andrews
Project Lead
Acting Program Delivery Manager
Surgery Program
Central Adelaide Local Health NetworkMandy Nolan
Director Nutrition and Dietetics
Central Adelaide Local Health NetworkDr Jackie Yeoh
GP Liaison Officer
Central Adelaide Local Health NetworkVicki Hume
Allied Health Lead
Surgery Program
Central Adelaide Local Health Network
Project Management
Dr Ecushla Linedale
Senior Project Officer
Health Translation SA
Other Content Experts
- Lesley Thomas
Orthopaedic Nurse Practitioner
The Queen Elizabeth Hospital
CALHN - Kate Southam
Joint Replacement Nurse Consultant
Orthopaedic & Trauma Services
Royal Adelaide Hospital
CALHN - Brianna Bates
Acting Director Exercise Physiology & Physiotherapy
Allied Health Lead Specialty Medicine 1
CALHN - Rhiannon Crane
Acting Director – Nutrition & Dietetics
Allied Health Lead-Acute & Urgent Care
CALHN - Assoc. Prof Anne Burke
Co-Director, Psychology
Allied Health Lead – Cancer
CALHN - Assoc. Prof Kathryn Collins
Co-Director, Psychology
Allied Health Lead – Cancer
CALHN - Jane Bollen
Primary Healthcare Nurse Consultant
BMP Consulting - Shivanji Jog
Acting Head of Unit
Acute General, Trauma and Sarcoma Surgery
Royal Adelaide Hospital
CALHN - Kerry Wakefield
Bariatric & Prehabilitation
Intermediate Care Services
The Queen Elizabeth Hospital
CALHN - Joanna Matters
Clinical Nurse/Diabetes
CALHN Diabetes Education Service
The Queen Elizabeth Hospital
We Want to Hear From You
If you are a South Australian GP or a person who has recently experienced surgery we would like to invite you to share your perspective and needs to help shape the development of this PreHab program.
We are holding an online focus groups in October to explore patient and GP perspectives on prehabilitation, understand what factors assist and hinder people getting healthier before surgery and get feedback on a draft resources.
Consumer Focus Group Opportunity
Click on the image below for more information about the Consumer Focus Group and how to register.
Project Enquiries
Dr Ecushla Linedale
Health Translation SA
Ecushla.Linedale@healthtranslationsa.org.au