Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project

Garry Tew, Robin Bedford, Esther Carr, James Durrand, Joanne Gray, Rhiannon Hackett, Scott Lloyd, Sarah Peacock, Sarah Taylor, David Yates, Gerard Danjoux

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Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good post-operative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients for surgery. This quality improvement project aimed to implement and evaluate a community-based prehabilitation service for people awaiting elective major surgery: PREP-WELL.

A multi-disciplinary, cross-sector team introduced PREP-WELL in January 2018. PREP-WELL provided comprehensive assessment and management of perioperative risk factors in the weeks before surgery. During a 12-month pilot, patients were referred from five surgical specialties at James Cook University Hospital. Data was collected on participant characteristics, behavioural and health outcomes, intervention acceptability and costs, and process-related factors.

By December 2018, 159 referrals had been received, with 75 patients (47%) agreeing to participate. Most participants opted for a supervised programme (72%) and were awaiting vascular (43%) or orthopaedic (35%) surgery. Median programme duration was 8 weeks. The service was delivered as intended with participants providing positive feedback. Health-related quality of life (EQ5D utility) and functional capacity (6-minute walk distance) increased on average from service entry to exit, with mean (95% confidence interval) changes of 0.108 (-0.023 to 0.240) and 35 m (-5 to 76 m), respectively. Further increases in EQ5D utility were observed at 3 months post-surgery. Substantially more participants were achieving recommended physical activity levels at exit and 3 months post-surgery compared with at entry. The mean cost of the intervention £405 per patient; £52 per week.

The service was successfully implemented within existing preoperative pathways. Most participants were very satisfied and improved their risk profile preoperatively. Funding has been obtained to support service development and expansion for at least 2 more years. During this period, alternative pathways will be developed to facilitate wider access and greater uptake.
Original languageEnglish
Article numbere000898
JournalBMJ Open
Issue number1
Publication statusPublished - 24 Mar 2020


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