Barriers to Implementation of Prehabilitation

As the demographics of global and European countries change, the healthcare systems need to review existing pathways and service models. An ageing population is being offered more complex and invasive surgical procedures. Furthermore, there is an additional risk with this changing population profile, especially due to increasing frailty, sarcopenia, the incidence of cancer is high, and complex co-morbidities. An emerging challenge for the surgical population is the higher prevalence of obesity. These patients, with complex co-morbidities and needs, form the so-defined "high-risk" surgical patients-who account for 12.5% of surgical procedures but 80% of deaths. Prehabilitation is emerging as an important intervention to address the risk to functional capacity and quality of life. Trials have shown reductions of complications, length of stay and readmissions postoperatively. The best impact is arguably when prehabilitation is multimodal (exercise, nutrition, psychological, and lifestyle) and personalised. This article aims to explore the barriers to the availability of prehabilitation in the UK. The authors found the three most significant barriers were cost-effectiveness, workforce shortage and lack of national policy at the time of publication.