Prehabilitation, from theory to clinical practice: Implementation and perspectives

The preoperative optimisation of a patient planned for major surgery can be improved by a multimodal approach named "Prehabilitation''. It consists of a program lasting about 4 weeks and includes medical care (to stabilise or improve active comorbidities), physical preparation (with personalised resistance and endurance exercises), nutritional preparation (intake of at least 1 g/kg/day of protein) and psychological support (anxiety management). The aim of this multimodal preparation is to bring the patient to the operation in a better condition. The implementation of a prehabilitation program requires to think about the patient's preoperative pathway: "identification'' as soon as possible of eligible patients, organisation of every initial visit and follow-up, maintenance of a link with the hospital during the program, personalisation of the therapeutic project. During an 18-month period, our institution has developed a routine care with prehabilitation for some surgical repair. This experience seems interesting to share with other care-providers because this prehabilitation program is logically followed in the postoperative period by enhanced recovery with the ultimate objective of reducing postoperative complications and returning home in better physical conditions.