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What does

Fit-4-Surgery Involve?

A multidisciplinary package of standardised, evidence based, individualised care—Risk Evaluation and Risk Optimisation—aimed at enhancing the functional capacity of deconditioned, sedentary and/or frail patients to help them withstand the stress of major surgery.

Risk Evaluation

  • Functional Capacity Testing: Fit-4-Surgery utilises Cardiopulmonary Exercise Testing (CPET) to assess patients’ fitness in order to:

    • Guide risk stratification

    • Formulate personalised, responsive and structured exercise prescriptions

    • Help patients and their surgical team decide on the timing and the extent of surgery (shared decision making)

    • Guide resource utilisation (e.g. high dependency and intensive care requirements after surgery)

  • Haematinic Screen - Patients are comprehensively screened for anaemia, bleeding or thrombembolic (clotting) risk, and necessary optimisations undertaken.

  • Nutritional Assessment - All patients are screened for nutritional deficits using standard measures of assessment.

  • Preoperative Anaesthetic Assessment - Chronic health issues will be assessed by specialists and a thorough review of medications performed on all patients.

Exercise Prescription

  • Exercise interventions are the cornerstone of the Fit-4-Surgery Program. Appropriately designed and delivered exercise regimes administered in the weeks prior to surgery improve fitness levels, enhance lung function and decrease complications after surgery.

  • Fit-4-Surgery utilises best practice exercise medicine incorporating the latest scientific evidence and advances. Prescriptions are targeted, personalised and responsive to each patient. Designed and delivered by an experienced Accredited Exercise Physiologist, the prescriptions incorporate evidence based behaviour change strategies to minimise barriers and maximise outcomes for patients.

Haematinic Optimisation

  • Following assessment, iron infusions, vitamin B12 and folic acid prescriptions may be required, and fast-track warfarin reversal implemented if necessary.

Nutritional Intervention

  • Eligible patients are referred to a nutritionist and offered targeted and individualised nutritional advice and interventions.

  • As part of the Enhanced Recovery After Surgery (ERAS) program patients having major surgery will receive carbohydrate loading prior to major surgery to reduce perioperative insulin resistance. Select patients will also be guided through weight management strategies.

Smoking & Alcohol Cessation

  • The benefits of smoking and alcohol cessation prior to surgery have been well documented. Eligible and willing patients will be referred to Quit services. Strategies will be addressed for support from social services as required.

Respiratory Function Optimisation

  • In addition to exercise prescriptions and quit smoking we will teach deep-breathing and coughing exercises to help reduce lung infection after major surgery.

Education

  • Patients will be provided with written information and nurse led information sessions on Shared Decision Making, Advance Care Planning, principles of ERAS (Enhanced Recovery After Surgery) and Information relevant to the patient’s surgical procedure.

Medical Optimisation

  • Patients will have their chronic co-morbid disease states and medications optimised to reduce their risk for postoperative complications; including referral to other specialists as needed e.g. cardiologist.

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