Prehabilitation (prehab) is a proactive approach to help you prepare for upcoming medical or surgical treatment. This preparation aims to enhance your fitness, health and mental resilience, thereby reducing the risk of complications and promoting faster recovery and better outcomes
Surgery today is safer than it has ever been. The majority of patients make a full recovery and return to their previous level of health.
However, a small proportion may suffer a complication after surgery. This might include an infection, such as a chest infection, or problems with the function of the heart, lungs or kidneys. Such complications can result in a longer stay in hospital, a delayed recovery and may even cause longer-term health issues. Importantly, there are things you can do to reduce the risk of complications.
The staff at NHS Lothian work together to make your operation and recovery go smoothly, but it all starts with you. We are here to support you through this process. Surgery, and recovery afterwards, puts an extra strain on the body, particularly the heart and lungs.
Being in the best health you can be will improve your chances of recovering quickly and help prevent complications. A few small changes will make a big difference.
This webpage offers advice and support on how you can best prepare yourself physically and mentally for surgery.
Physical Activity
Having an operation and the recovery afterwards have been compared to exercise because they place a strain on the heart, lungs and muscles. Physical activity and training help prepare your body for exercise and the same is true before an operation. Improved fitness levels allow your body to cope better with the physical stress of surgery and will reduce your chances of complications.
The benefits of improved fitness before surgery include:
- Leaving hospital sooner
- Returning to a normal quality of life more quickly
- Reducing your risk of heart disease, stroke and diabetes
- Improving blood pressure control and cholesterol levels
- Helping with weight control
- Reducing anxiety and stress
What to do…
If you are normally an active person, we would encourage you to continue doing the activities that you enjoy before your operation.
If you are normally less active, the good news is that it’s never too late to start seeing benefits from regular exercise. The even better news is that you don’t need to do much and every little helps.
You should increase what you do gradually, but as little as 30 minutes, 5 days per week is enough to improve your fitness.
You should be exerting yourself hard enough so that your heart rate goes up and your body feels warm. So why not find something that you enjoy and make a start today? Get your friends and family involved, or join a group, to make it even more enjoyable and help you stay motivated. It is important to increase the amount of exercise you do gradually. If you have a heart or lung condition, or have any concerns, speak to your GP, surgeon or pre-assessment nurse before starting an exercise program.
For more information see the NHS Inform Keeping Active websiteopens a new window
Food
In order for your body to recover from surgery, it needs the right energy and nutrients. A healthy balanced diet is important to help prepare your body for surgery.
You should aim to eat three regular meals with a good balance of the food groups – protein, carbohydrates and healthy fats. Try to avoid adding any extra sugar or salt to your diet.
For more information see the NHS Inform Eatwell Guide: How to eat a healthy balanced dietopens a new window
Fuelling your recovery after surgery
Vitamins and minerals are crucial to recovery after surgery, for example iron, folate, zinc and vitamins A, C and K. Try to get as many different types as possible by eating a healthy balanced diet with a good intake of fruit and vegetables. Aim to eat 5 different portions each day.
Poor appetite and/or weight loss
Depending on why you’re having surgery, some people may actually lose weight without trying before their operation. It is important your body has good energy stores to recover after surgery. If you have lost weight without trying to, or have a reduced appetite, try these simple changes to stop any more weight loss:
- Eat little and often – try 5-6 small snacks or meals per day
- Take drinks after meals and not before
- Use full fat milk and full fat dairy products
- Add margarine or butter to mashed potatoes
- Add grated cheese and/or cream to soups and sauces
More information…
If you want more information about a healthy balanced diet, and would like some delicious meal suggestions, then you can find more information on the NHS Eat Wellopens a new window and British Dietetic Associationopens a new window websites.
Smoking
If you are a smoker, stopping, or even cutting down, before your surgery is one of the best changes you can make to improve your health. Smoking puts an additional strain on your heart and lungs and increases the risk of complications during and after surgery. Smoking increases the risk of problems during or after your operation.
Heart
- reduced oxygen supply to heart and body
- heart attack
Lungs
- difficulty breathing during or after surgery
- chest infection or pneumonia
- collapsed lung
Blood clots
- blood clots in your veins or lungs
Bones, skin and wounds
- impaired healing and scaring
- wound infection
Immune system
- increased risk of infection
Vaping
Vaping, or using an e-cigarette, is not as harmful as smoking cigarettes. However, we don’t yet know the long-term health consequences. Vape liquid still contains nicotine, which increases your heart rate and blood pressure and puts a strain on your heart. We would also advise avoiding vaping before your operation.
What you can do…
The important thing is that stopping smoking before surgery reduces your risk of these complications. The longer before your operation you can stop, the better. However, even avoiding cigarettes in the last few days can help.
An operation provides a great opportunity to improve your long-term health by stopping smoking. Perhaps it could be an opportunity to quit smoking for good?
Support to stop…
Quitting smoking is not easy, but we are here to support you. Maybe you could also get your friends and family to help by stopping at the same time?
If stopping is something you are motivated to do, speak to your surgeon or pre-assessment nurse who can refer you to our smoking cessation service. They offer individual and group support, as well as a range of nicotine replacement options.
For more information see the NHS Inform stopping smoking websiteopens a new window
Alcohol
Alcohol, like all things, should be enjoyed in moderation. You don’t need to totally avoid alcohol before your operation, but we would advise that you stay below the recommended maximum amounts.
For both men and women this is less than 14 units per week, with no more than 3-4 units on any single day.
This would be around one and a half pints of beer, or two small glasses of wine.
You should avoid alcohol in the 24 hours before your operation.
Medical Conditions
Medical conditions can affect your recovery from surgery. It is important to make sure any conditions you have are controlled as well as possible before your surgery.
Diabetes
Good blood sugar control is really important to reduce your risk of infections. Talk to your diabetes nurse early to see if they need to make any changes to your treatment.
Blood Pressure
Blood pressure should be controlled to reduce your risk of stroke. Have your blood pressure checked at your GP surgery in good time before your operation. Your GP can then change your medication if needed.
Heart, lung, and other medical problems
If you have any other long-term medical problems, consider asking your GP or nurse for a review, especially if you think your health is not as good as it could be.
Anxiety and mental health
Most people feel some anxiety about having surgery. If you are very anxious or upset, it may be helpful to talk about your concerns with your GP. Techniques including mindfulness, relaxation and breathing exercises or yoga could help you relax before and after your surgery.
Dental health
If you have loose teeth or crowns, a visit to the dentist may reduce the risk of damage to your teeth during an operation.
Are you going to get fit for surgery?
Are you going to prepare your body as best as possible and get fit for surgery? Although it may seem daunting, it is possible to make a few small changes that will make a big difference.
We are here to support you through this challenging time. If you have any questions about what you’ve just read then ask your pre-assessment nurse, surgeon or anaesthetist who will be able to guide you further.
Research
NHS Lothian is committed to supporting clinical research. If you are eligible for any research studies, someone from the research team may contact you with information that you can read. If you do not wish to take part in any research, this will not affect your clinical care in any way.
FURTHER INFORMATION
Fitter, Better, Sooner is a toolkit aimed at helping patients to prepare physically and psychologically for surgery. It was produced by the Royal College of Anaesthetists, with representatives from the Royal College of General Practitioners (RCGP) and the Royal College of Surgeons (RCS), and with patient representatives playing key roles on the working group, reflecting the importance of multidisciplinary input for optimal perioperative care. The resources have been endorsed by both the RCGP and RCS, and have been awarded ‘highly commended’ in the BMA Patient Information Awards 20191.
For more information see the Fitter, Better, Sooner websiteopens a new window
PLEASE NOTE
This website includes content taken from the Royal College of Anaesthetists’ (RCoA) leaflets ‘Fitter, Better, Sooner (2018)’, ‘You and your anaesthetic (2020)’, ‘Anaesthesia explained (2015)’, and ‘Common events and risks in anaesthesia(2019)’. However, The RCoA has not reviewed the website as a whole. Some of the RCoA infographics used on the website have been adapted for web viewing.
