Significant global interest in replicating the MUHC’s successful Prehabilitation Program

Dr. Liane Feldman spoke about the ground-breaking Prehabilitation Program of the McGill University Health Centre (MUHC) recently at the 2024 American College of Surgeons Clinical Congress, an event that brought together close to 10,000 surgeons from around the world. Dr. Feldman is the Surgeon-in-Chief and Medical Director of the MUHC Surgical Mission, and a proud ambassador for the Prehabilitation Program run at the Montreal General Hospital (MGH) which is world-renowned for developing this extremely innovative approach to help patients recover faster after surgery.  

“There is always a certain amount of time between the decision to have an operation and the date that the surgery is performed. The Prehabilitation Program uses that time wisely, boosting the patient’s functional status, exercise capacity, nutrition and medical conditions prior to surgery,” Dr. Feldman explains.  

Prehabilitation is a multimodal program initiated before surgery. A person is evaluated for their exercise tolerance, physical strength, nutrition and mental health, and a customized plan is drawn up for them by a multidisciplinary team. Perioperative physicians, nurses, kinesiologists, physiotherapists, and nutritionists are all included and provide their expertise. The prehabilitation program generally spans 4 to 5 weeks before surgery and will usually include aerobic and strength exercises, protein and energy supplementation, anti-anxiety strategies, managing blood sugar levels, and alcohol and smoking cessation.  

“The goal is to boost up patients before surgery so there is more reserve to handle the metabolic stress of major surgery, reducing complications and decreasing the time it takes to be ready to return to normal activity, or to be strong enough to receive other intensive treatments after surgery such as chemotherapy. It’s kind of like training someone before a marathon,” explains Dr. Feldman.

The MUHC is considered a pioneer in multimodal prehabilitation in large part due to the foundational work of Dr. Franco Carli, previous Chair of the McGill Department of Anesthesiology and retired MUHC anesthesiologist who was among the first worldwide to study and implement prehabilitation. “The MUHC’s success in prehabilitation has set a global standard, with Dr. Carli's research serving as a cornerstone,” notes Dr. Feldman. “His work, which includes extensive randomized trials and clinical studies, has demonstrated the clear benefits of prehabilitation for patients undergoing major surgery.”  

Significant interest in the MUHC’s model  

At the conference, surgeons from all over the world displayed significant interest in replicating the MUHC’s success, with many expressing a desire to implement a prehabilitation program at their own hospitals. These surgeons were particularly impressed by the multidisciplinary approach that has proven so effective at the MUHC.  

“Our multidisciplinary prehabilitation clinic currently services around 200 high-risk patients per year, and we see success story after success story. But we know there are so many more patients that could benefit from this approach,” Dr. Feldman notes.  

The MUHC’s Prehabilitation Program has indeed grown significantly since its inception in 2012, with support from the Montreal General Hospital Foundation. Recently, an application was made to the ministry to enable sustainable funding and expand the program further.  

The Prehabilitation Program is a natural lead into our Enhanced Recovery After Surgery (ERAS) programs, which have made the MUHC a recognized leader in surgery. Along with our use of minimally invasive, robotic, catheter-based and endovascular techniques, these programs complement one another with the ultimate goal of minimizing surgical risks and fostering smoother recovery for patients.