Enhancing postoperative recovery with multimodal prehabilitation: the journey begins before surgery

Figures

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  Fig. 1.. Multimodal prehabilitation improves preoperative functional capacity and enhances postoperative outcomes by addressing modifiable surgical risk factors, such as low cardiopulmonary reserve, reduced physical activities, malnutrition, sarcopenia, frailty, and low psychological reserve.

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  Fig. 2.. Targeted patient care in multimodal prehabilitation programs: one size does not fit all. A severely malnourished patient should primarily receive nutritional support, supplemented with an exercise regimen as tolerated. Conversely, a patient with severely impaired physical function but adequate nutrition should focus on exercise training while maintaining their current diet with basic nutritional education. If a patient is sarcopenic, both nutritional and resistance exercise interventions should be prioritized.

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  Fig. 3.. Multimodal prehabilitation program at Montreal General Hospital. Patients identified as high-risk during screening undergo assessment, intervention, and follow-up in the prehabilitation clinic while simultaneously following the ERAS pathway in the preoperative clinic, resulting in optimized preoperative status. DASI: Duke Activity Status Index, CNST: Canadian Nutritional Screening Tool, FFMI: Fat-Free Mass Index, HADS: Hospital Anxiety and Depression Scale, CPET: Cardiopulmonary Exercise Test, PG-SGA: Patient-Generated Subjective Global Assessment, ERAS: Enhanced Recovery After Surgery.

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  Fig. 4.. A multi-stakeholder perspective on implementing multimodal prehabilitation in South Korea. The figure illustrates a stepwise strategy for identifying and overcoming barriers at the government, hospital, healthcare professional, and patient/family levels, based on South Korea’s unique healthcare system and socio-cultural context. VBHC: Value-Based Health Care, EBM: evidence-based medicine.