Turning ‘waiting lists’ for elective surgery into ‘preparation lists

Levy N et al. Turning ‘waiting lists’ for elective surgery into ‘preparation lists’. BJA. 2020. DOI: 10.1016/j.bja.2020.08.021

What is already known:

Waiting lists for elective surgical procedures are a feature of centrally-funded healthcare systems. The global population is ageing and there is increasing associated comorbidity producing an increasing requirement for healthcare and surgical procedures. Overall the number of patients on waiting lists is set to continue growing. Large surgical waiting lists can have wide-ranging negative effects including the impact on the individuals’ physical and mental health, the impact on society – healthcare, economic, social and political and the increased pressure on health and social care workers. The preoperative phase represents a valuable window of opportunity to optimise chronic comorbidities, improve physical health and psychologically prepare an individual for surgery. This approach has been shown to improve patient outcomes and satisfaction following surgery and is a key tenet of ERAS pathways.

What this paper adds:

This interesting and thought-provoking editorial highlights the potential benefits of making a conceptual change as to how we as a society approach elective surgical waiting lists. The authors explain in a logical and systematic fashion the rationale for moving from a passive situation where ‘waiting lists’ are viewed negatively as time spent in stasis with a debilitating health condition to a proactive approach where ‘preparation lists’ are viewed as an opportunity to address comorbidities, improve physical health and psychologically prepare patients for their surgery. The potential benefits of making this change are enormous, encompassing positive impacts on patient outcomes and experience as well as on society as a whole.

Dr Leigh Kelliher, Royal Surrey County Hospital NHS Foundation Trust, UK.


Prehabilitation for the Enhanced Recovery After Surgery Patient

Shanahan JL, Leissner KB. Prehabilitation for the Enhanced Recovery After Surgery Patient. J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):880-882.

What is already known:

The preoperative preparation of the surgical patient is a key part of a successful ERAS programme. Prehabilitation follows on from this by trying to improve the functional status of a patient by a series of interventions including exercise.

What this paper adds:

This is an interesting review of prehabiliation and the benefits thereof. But not just exercise programmes but also nutritional optimisation, anaemia and diabetes optimisation, and finally smoking and alcohol cessation.

Chris Jones, Guildford. @chrisnjones


Preoperative Nutrition and Prehabilitation

Gupta R, Gan TJ. Preoperative Nutrition and Prehabilitation. Anesthesiol Clin. 2016 Mar;34(1):143-53.

What is already known:

Preoperative nutrition and prehabilitation are two potentially important interventions in preparing patients for surgery.

What this paper adds:

Comprehensive review on preoperative nutrition – including assessment and optimisation, immunonutrition and how to avoid insulin resistance. And prehabilitation – including assessment (e.g. cardiopulmonary exercise tests and 6-minute walk tests) and exercise programs.

Chris Jones, Guildford.


Starvation, carbohydrate loading, and outcome after major surgery

William J Fawcett, Olle Ljungqvist, BJA Education, Volume 17, Issue 9, 1 September 2017, Pages 312–316,

What is already known:

Preoperative carbohydrate loading has long been an essential part of a successful ERAS programme, where it modifies insulin resistance, improves patient comfort and wellbeing, minimises protein losses, and improves postoperative muscle function.

What this paper adds:

This excellent review written by two executive committee members of the ERAS Society explores the metabolic changes and stress response following major surgery, the mechanism by which insulin resistance arises. They summarise the evidence behind carbohydrate loading, and in particular explores the more controversial use in patients with diabetes.

Chris Jones, Guildford.