Preparing for surgery: The community pre-habilitation and wellbeing project (the PREP-WELL Project)

Surgery places major physiological stress on the body, with patients who are less fit at highest risk of complications. Adverse lifestyle choices such as sedentary behaviour, poor diet, smoking and excess alcohol are associated with poor outcomes following surgery, reduced longer-term survival and increased health care costs.  

Current ‘fitness for surgery’ decisions occur late in the preoperative pathway, in secondary care, which doesn’t allow enough time to improve patient health or change behaviours. Opportunities are therefore often missed.

This ‘pre-habilitation before surgery’ project is led by South Tees Hospitals NHS Foundation Trust, in partnership with NHS South Tees Clinical Commissioning Group, Public Health Middlesbrough, Redcar and Cleveland, Northumbria University and ELM Alliance Ltd.

A new community-based pre-operative service will be piloted for up to 100 patients who are undergoing major surgery. Suitable patients will be offered a supervised ‘pre-habilitation’ programme to improve health and fitness before surgery.

Following an initial health evaluation, each patient will receive a tailored programme consisting of supervised lifestyle support to improve fitness. This will include one-stop access to smoking and alcohol services, supervised exercise, nutritional and psychological support in a six-week programme prior to surgery. Those who are unable to attend will be offered a facilitated home-based self-management option, with regular contact by the project team.

Following surgery, patients will be offered support for self-managed rehabilitation or the option to re-attend sessions at the community public health facility.  

The intervention aims to capitalise on the ‘teachable moment’ of impending surgery to encourage positive behaviour modification.

Contact information

For more information about this project, please contact Professor Gerard Regis Danjoux, Consultant in Anaesthesia and Sleep Medicine, South Tees Hospitals NHS Foundation Trust.