Prehabilitation: Educating and engaging patients prior to surgeries

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More than 60 VPSA members gathered in person and online recently to hear an update on the Surgical Patient Optimization Collaboration (SPOC). This initiative launched in May 2019 at 15 sites across BC to provide system change strategies, funding support, and shared learning to interdisciplinary teams regarding the significant impact prehabilitation can have on improving patients’ surgical outcomes. SPOC’s purpose is to improve assessment and management of elective surgical patients, which will in turn reduce adverse events, increase patient and caregiver satisfaction, and improve post-operative outcomes.

The initiative requires collaboration and communication with a team approach between physicians and patients.

“Family physicians can play an important role in the SPOC process,” said Dr. Lesley Wood, a family physician who has worked with the collaborative since its beginning. “A major surgery is a time when many patients may have a significant motivation for change. Patients may be willing to stop smoking, improve their nutrition, increase their physical activity, treat their iron deficiency, or optimize their glycemic control. All these things can improve their surgical outcomes.”

The initiative has 13 optimization components: nutrition; smoking cessation; anemia; sleep apnea; physical activity; frailty; social supports; pain management; mental health; substance use; cardiac disease; VTE prophylaxis; and glycemic control.

The collaboration has allowed for the development of a number of resources including a BC Surgical Prehabilitation Toolkit. Data from the 15 sites was initially going to be collected until September 2020; however, surgery delays because of the pandemic have affected its timeline and the initiative will continue now until May 2021. Still, early results are encouraging.

“Seventy-seven per cent of the patients we tracked agreed that their overall health improved as a result of the information and care provided by their surgical perioperative team and 87 per cent agreed their surgical experience improved as a result of this,” said  Geoff Schierbeck, Doctors of BC Liaison for Surgery and Co-Lead for BC SPOC Initiative. “We need patients to see the value of prehabilitation. We need them to be involved to improve their outcomes.”

Anesthesiologist Dr. Kelly Mayson co-leads the initiative and emphasizes that it is very much a team collaboration.

“Our goal is to identify and triage patients with modifiable risks prior to surgery and create a personal care plan to help support them and prepare them,” she said. “The sooner we can have them working on that personal care plan, the better. We are looking to change the patient pathway so that new surgical patients take a screening questionnaire early on to identify if they are at low, medium, or high risk because of comorbidities. We provide them with educational materials and encourage them to change their behaviours. It’s important that we make our resources as easy to understand and as user-friendly as possible.”

COVID-19’s impact

While elective surgery slowed down in the spring with an emphasis focusing on oncology and urgent and emergent cases, the SPOC team has reviewed 349 surgeries in gynecology, urology, and spine from mid-March to mid-June 2020. At least 83 per cent of patients who were screened had an identifiable area of optimization.

Dr. Mayson touched on the potential value of virtual optimization, stating that multiple centres in the United Kingdom have rolled out programs despite a higher COVID incidence and tapped into community resources.

“It can be done. You need the will and the want. We’re hoping to move towards better solutions at VGH and UBC.”

Case studies

As part of the recent SPOC presentation update to VPSA members, Drs. Jacqueline Trudeau and Breay Paty presented case studies to show the effect of prehabilitation of anemia and glycemic control on patient outcomes. They also gave office management suggestions. Dr. Trudeau is an anesthesiologist and the medical director for the Perioperative Blood Management Program; Dr. Paty is a clinical associate professor in the Division of Endocrinology at UBC.

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