Prehabilitation making surgery easier

The study, conducted by Ms Sally Griffin, Dr Lynda Ross, Dr Michelle Palmer, Dr Ben Desbrow and Dr Matthew Burstow reports surgeons found it easier to operate and had greater access to target structures on obese preoperative patients who were prescribed to a VLCD Clinic prior to surgery.

Key findings for obese patients who undertook dietitian led treatment via the VLCD Clinic model prior to surgery include:

– An average of 9kg loss (7.4 per cent body weight).
– 70 per cent lost sufficient weight for surgery.
– An average of 10 weeks to achieve weight loss.
– 93 per cent attendance rate (of 524 appointments).
– 60 per cent believed they could not have lost weight without the clinic.

Surgeons reported the VLCD Clinic model had:

– Made operations easier (83 per cent)
– Improved access to target structures (75 per cent)
– Allowed easier laparoscopic access (58 per cent)
– Reduced intraoperative blood loss (58 per cent)

Additional research:

– 1 in 3 adults in Australia fall within the obese category of a Body Mass Index of 30 or above.
– In some towns in Australia, it’s as high as 42 per cent.
– Obesity rates have tripled in Australia since 1975.
– This increase is paralleled by an aging population, leading to an increase in elective surgery for conditions such as gallstones, ventral hernia, liver failure, endocrine for which obesity is a risk factor.
– 1 in 5 thyroid cancers will be attributable to obesity in the coming decade.

Ms Griffin an accredited practicing dietitian at Logan Hospital said the preoperative VLCD model of care is the first of its kind.

“Prehabilitation, via a VLCD Clinic is a collaborative approach between the surgeon, dietitian and patient,” Ms Griffin said.

“In the past, many patients were told by a surgeon they were simply too big for surgery.

“The VLCD Clinic model is changing that by helping obese pre-operative patients lose weight in a safe and supportive environment.

“Studies have shown that VLCDs can elicit weight loss of 1-2.5kg per week, reduce liver volume and visceral fat, improve blood pressure, blood glucose control, and exercise tolerance.”

Initially implemented in Logan Hospital in 2017, Queensland Health has now expanded the program, with preoperative VLCD Clinic’s now available in Brisbane, Cairns, Ipswich, Redcliffe, Redlands and Toowoomba.

*VLCD includes

– ≤800kcal per day.
– Meal replacement products.
– Nutritionally complete.
– Requires prescription and monitoring by dietitian with VLCD expertise.
– Discipline and motivation required.

Ms Griffin’s research will be unveiled at the the Royal Australasian College of Surgeons Annual Scientific Congress in Brisbane (2-6 May).

The Congress is the largest multi-disciplinary surgical meeting held in the southern hemisphere and brings together some of the top surgical and medical minds from across New Zealand, Australia, and the rest of the world.

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