Table 1 VSS Presentations: a brief overview

1. Welcome and evidence for the session

• Introduction to prehabilitation team

• Story of previous patient with successful outcome

• Encouragement to participate in Surgery School

2. Respiratory care bundle (aCOUGH) including

• Risks of post-operative chest infection: lung collapse, body’s lung cleaning mechanism physiology

 Active cycle of breathing technique instructions

• Airway clearance technique including controlled breathing, deep breathing, huff and cough

 Oral care

• Attend the dentist/hygienist

• Use an alcohol-free antiseptic mouthwash daily

• Brushing teeth twice daily

 Get out of bed

• Sit up straight in bed and sit out of bed to promote early post-operative mobilisation

• Gradual return to activity after surgery

3. Exercise prehabilitation

• Smoking cessation

• Benefits of exercise

• Recommendations: avoid inactivity, physical activity to meet recommended guidelines, breathing exercises 5–10 min daily.

• Monitoring intensity

• Early post operative mobilisation.

• Tips for safe exercise and starting an exercise program prior to surgery

4. Nutrition before surgery

• Effect of surgery on nutrition

• Nutrition to increase muscle stores: exercise + eat/drink protein + eat/drink enough energy

• Maintain weight

• Follow Healthy Eating Guidelines

• Post operative nutrition

5. Pain management after surgery

• Causes of pain after surgery

• Daily pain assessment

• Commonly used pain relief: PCA, epidural, spinal injections, tablets, wafers, liquids.

• Common Side Effects incl: nausea, vomiting, rash/itch

6. Psychological preparedness and relaxation

• Why focus on psychological wellbeing? Prepare for surgery, cope with surgery, recover from surgery

• Strategies to manage worry e.g. relaxation strategies

• Staying motivated and goal setting

• Using family and friend supports