Implementation of a surgical prehabilitation pathway at a tertiary surgical centre during a global pandemic

Background: Prehabilitation is the process of enhancing a patient’s functional capacity before a stressful event such as major surgery. By allowing patients to ‘wait well’, prehabilitation has been proposed as one intervention able to transform the preoperative period into active preparation time. In addition, owing to prolonged surgical waiting times because of the COVID-19 pandemic, recommendations for prehabilitation have begun to appear in guidelines around preparation for surgery.1 In this context, we set out to develop a new prehabilitation service in a tertiary referral centre with a dispersed geographical referral space. Methods: We collaborated with partner programmes (the MILE) to set up a multimodal, personalised, prehabilitation service consisting of exercise, nutrition, and coaching. We aimed to reduce the in-hospital footprint using technology such as video and telephone consultation. Our prehabilitation service was developed by a multidisciplinary team, who comprehensively mapped the pathway and engaged stakeholders. Virtual prehabilitation clinics were set up with a generic ‘script’ for consultations developed by the team and personalised for each patient. Carefully planned remote interventions and support for exercise, nutrition and coaching were established. The programme was rolled out for three cancer surgery pathways as a pilot project. We worked with electronic medical records (EPIC®) to create a referral and management pathway for the service. In addition, a REDCap database was set up to accrue clinical data, as part of an ongoing Quality Improvement (QI) process. Additional feedback from referring teams was sought regarding how prehabilitation has impacted their services, and fed into the QI process. Results: Fifty-eight patients have been referred to the service over a 6-month period. Eleven patients have completed their third digital prehabilitation clinic. Of these patients, there has been an increase in average 30-s sit-to-stand test scores from 12.1 to 18.8. The average visual analogue fatigue scores have reduced by 1 despite most patients undergoing neoadjuvant chemotherapy. The team has received good qualitative feedback, with many patients reporting an increase in self-confidence and motivation. Patients have also enjoyed speaking regularly to the prehabilitation team and would otherwise have felt at a loss of what to do whilst waiting for their surgery. Conclusions: Patients have begun to show an improvement in functional capacity from our digitally delivered prehabilitation service. In addition, we have received good qualitative feedback from patients and referring teams. We aim to continue to improve our service as it extends to other surgical pathways. An internal UCLH Transformation Bid was used to fund the pilot of this project.