Prehabilitation, often referred to as "prehab," uses the period before surgery to prepare both your body and mind for the upcoming demands of the operation. It involves travelling upstream to prepare for what we might find downstream.
Prehab represents a paradigm shift away from the traditional, reactive model described in a previous post by empowering individuals to actively engage in their own treatment.
While the specific components of prehab can vary, they typically include a combination of physical fitness, nutrition, and psychological preparation.
Studies have shown multiple benefits across different patient populations undergoing various surgical procedures. A reduction in post-operative complications is just one of the reported advantages.
Regrettably, prehab remains a relatively unknown concept, and dedicated programs are not yet widely accessible. This serves as a shining example of the challenges faced by many healthcare agencies in balancing resource allocation for immediate needs against investments in preventive measures.
To realize these opportunities for prevention, we must embark on a journey upstream.
The Power of Going Upstream
This post draws inspiration from the thought-provoking book "Upstream: The Quest to Solve Problems Before They Happen" by Dan Heath.
In the book, he eloquently asserts,
To go upstream is a declaration of agency. I don't have to be at the mercy of these forces - I can control them. I can shape my world.
He also offers a perspective deeply relevant to surgery, stating, "You want the probabilities overwhelmingly in your favour. Upstream work is about reducing the probability that problems will happen."
The concept of "upstream" originates from the realm of public health and is often attributed to the pioneering work of medical sociologist Irving Zola.
The classic story goes something like this. A couple are fishing when they suddenly see a man floating by screaming “I can’t swim.” They both rush in to pull him out. As they are dragging him to shore, a woman floats by flailing her arms, struggling in the same way. They run in and pull her out. As they catch their breath, someone else floats by, about to go under. The man runs in to assist, but his partner starts running upstream. “Where the heck are you going?” he yells. “To keep people from falling in the river!!,” she responds.
This is what prehab does… it prepares you… protects you… and decreases the need for rescue.
Downstream actions taking place post-surgery react to problems after they have occurred. Upstream efforts prior to surgery aim to prevent those problems from happening at all. Or to decrease their impact if they can’t be avoided altogether.
As the body of evidence supporting prehabilitation grows and the concept gains broader recognition, we confront another challenge: determining who is responsible for guiding us on this upstream journey.
Upstream Work Requires Ownership
Once a problem has been identified, such as prolonged recovery from surgery, and solutions like prehab have been found, the question arises: Who implements this solution?
The complexity of bringing prehab to those who would benefit from it is further compounded by the involvement of multiple stakeholders.
Take nutrition, for instance. We have plenty of evidence indicating that malnutrition negatively impacts surgical outcomes, resulting in longer hospital stays, increased complications, and elevated mortality rates post-surgery. And there is compelling evidence to suggest that improving a patient’s nutritional status before surgery can yield significant benefits.
The question then becomes: Whose responsibility is it to address this issue? Currently there are few hospital-based prehab programs, individual surgeons and anesthesiologists can offer minimal guidance as they lack training in nutrition, and registered dieticians rarely have the opportunity to see patients before surgery. Making prehab accessible to the broader population will require the involvement of numerous health care providers, a process demanding time and dedication.
So let's examine this from a different perspective.
You want the probabilities overwhelmingly
in your favour.
If the upstream efforts of screening for malnutrition and implementing nutritional therapy are not carried out, who will suffer the most downstream consequences?
The consequences of malnutrition-related complications might have some impact on the surgeon, the hospital or the insurer. It might lead to additional surgeries, demanding more hospital resources and costing insurers.
But you, the patient awaiting surgery, will endure the most profound consequences – and you have the most to gain by undertaking a prehab program. So if you are awaiting surgery, I encourage you to take action now in pursuit of your best interests.
The Balanced Approach: Opt for Prevention AND Intervention
In the pursuit of a seamless, complication-free surgical recovery, a comprehensive approach involves both upstream and downstream protection mechanisms - shields and swords, as I referred to them in a previous post.
In a healthcare landscape with limited resources, striking a balance between prevention and intervention is paramount. Downstream efforts are essential, providing a safety net, while upstream work can diminish the downstream resource demand, benefiting patients and their families while alleviating the burden on the healthcare system.
My advice if you require major surgery? Focus on what you can control. Entrust reactive post-surgical care to medical experts, and let hospitals handle hospital-based preventive measures. You haven’t much choice in this matter. However, you do have the choice to undertake some very effective proactive prevention strategies.
Armed with the knowledge you've gained here and on the rest of this website, you can head upstream now yourself and tilt the odds for a quick recovery in your favour.
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