With the advances in diagnostic, medical therapy, surgical and anaesthetic care, curative or palliative surgery can be considered in older patients or those having more complicated background medical conditions whom may have been precluded from surgical options by patients himself or the clinical team in the past because of the anticipated high perioperative complication rate. With the introduction of preoperative Cardiopulmonary Exercise testing, we are able to not only evaluate one’s cardiopulmonary reserves and thus fitness to combat the peri-operative stress more precisely and objectively, but also to describe one’s impairment profile that provides a foundation for optimization possible through an integrated prehabilitation programme that involved medical optimization, physical training, nutritional intervention and health behavioural modification.
In our centre, we have pioneered a service model collaborated with the anaesthesiologists and surgeons. Patients planned for high risk non-cardiac surgery are co-evaluated by anaesthesiologists and prehabilitation physicians clinically and by CPET assessment. Patients with borderline performances with low VO2 Peak/ VO2 AT +/- high VE/VCO2 were recruited for a 2 – 4 weeks integrated prehabilitation training with pre-determined goal. Most patients are considered high-exercise risk because of the background comorbidity and required specialist-led training. Different from service models elsewhere, medical review and optimization are provided concurrent to the exercise training under close medical supervision if possible. Surgery will be proceeded as planned once the goal is achieved within the operable time frame. For those performed less favourably, they are counselled preemptively along the prehabilitation “journey” in order to facilitate a final shared decision that is to the best interest of that patient.
