Feasibility of prehabilitation before major urological surgery in the Hungarian Public Health Care System

Megvalósíthatósági vizsgálat, avagy hol van a műtéti felkészítés helye a magyar egészségügyben

Abstract

Abstract

The period from diagnosis to surgery offers an opportunity for prehabilitation, i.e. improving the physical and mental well-being of patients, thereby reducing the risk of postoperative complications. Although the effectiveness of prehabilitation has been demonstrated in numerous studies, its use is not yet standard care in our country.

The project, jointly organised by the Péterfy Sándor Utca Hospital and the Centre for Management Training at Semmelweis University, aimed to provide multidisciplinary support to patients undergoing cystectomy and to assess the feasibility of the programme. To this end, we have developed a prehabilitation framework providing surgical preparation, which we intend to be applicable before any planned major surgery and which can be easily integrated into the practice of healthcare institutions. 

During the pilot program, we conducted multidisciplinary prehabilitation coaching of three high-risk patients with the participation of physiotherapy, dietetics and psychology, complemented by one session of medical information and consultation. Patients continued the learning at home with the help of the programme's publications. Improvements in functional capacity and nutritional status were observed, and patients became motivated and actively involved in their own complex treatment.

Based on the risk grouping (and estimated willingness to participate), individual coaching could be planned for 60-80 patients in the study ward with 2000 surgeries per year, and small group coaching for a further 500-600 patients. 

Training can be provided in outpatient care, although funding for the different professions is not balanced. The literature suggests that prehabilitation not only reduces complications and missed operations, but is also cost-effective. Successful implementation requires multidisciplinary collaboration and the education of the entire care team.