Patient Care

Washington University’s Surgical Prehabilitation and Readiness (SPAR) Program

The “Surgical Prehabilitation and Readiness” (SPAR) program is an ongoing initiative at Washington University School of Medicine. Rather than focusing on recovery and rehabilitation after a procedure, “prehabilitation” prioritizes care and physical therapy before the patient undergoes their surgery. This process can better prepare a patient and optimize health for a major operation.

Prehabilitation can be compared to training for a physical activity. Athletes will practice for a long period to prepare their bodies for the sport they will engage in. For similar reasons, preparation for a surgical procedure will ready the patient for the operation and for healing afterwards. Washington University Surgery launched the SPAR program to improve the health outcomes of its patients.

SPAR at Washington University

The SPAR program is a holistic mind and body approach. It goes beyond exercise or focusing on diet, as it also includes mindfulness and education components. This allows patients to be comfortable with and understand the surgical process as well as what to expect before, during and after operation.

Dr. Dominic Sanford

Dr. Dominic Sanford of the Washington University Hepatobiliary-Pancreatic and Gastrointestinal (HPB-GI) Surgery is leading the SPAR program. The initiative was modeled off past projects within the department. SPAR at Washington University has a focus on the patient population of our regional community. Patients are referred, screened and selected by physicians for their ability to benefit from this program.

Dr. Sanford and his team have found that interventions through the SPAR program can improve patient outcomes, especially in complex procedures. The SPAR program is seeking to expand into all departments and many types of surgeries. Target patients for SPAR are those above seventy who are predicted to have an in-patient prediction time of over two days. SPAR programs are initiated at least two weeks before the scheduled surgery.

Dr. Ryan Fields

“The SPAR program has unlimited potential. We think that it’s going to improve almost every measurable outcome we can think about,” says Dr. Ryan Fields, Chief of Surgical Oncology and a leader in the SPAR program.

Patients have been engaged in the SPAR process by monitoring their activity and how this has impacted their recovery after surgery. Dr. Fields has witnessed this firsthand. “It’s been an exceptionally positive experience. Patients have felt better prepared, and objectively they’ve had fewer issues after surgeries.”

Components of the Program

SPAR outlines four major components of prehabilitation, including physical activity, strengthening the lungs, healthy diet and mental health practices.

Activity in SPAR includes important goals that are set by the SPAR coordinator. This aspect of the program includes regular exercise to increase strength, such as tracking daily step count using a Fitbit monitor. Research has demonstrated a correlation between a stronger, more fit body and better health outcomes after surgery. A physical activity program includes activities that the patient enjoys so they can be motivated to continue achieving their goals. An activity log is provided to keep track of exercise.

Strengthening the lungs for surgery is highly recommended. SPAR provides patients with an Incentive Spirometer, a device that trains the lungs to reduce breathing problems after surgery. It increases oxygen flow, reduces pain and decreases the potential of developing pneumonia. Stopping all smoking and the use of nicotine products is also part of SPAR’s initiative for strengthening the lungs.

A healthy diet provides the body with nutrition and digestive preparation in the weeks leading up to a major procedure. Good food contributes to easier, more efficient recovery and healing. Improving the diet may involve the addition of good carbohydrates for energy, increasing protein intake for muscle recovery and focusing on fruits, vegetables and whole grains while limiting sugar. Meal supplements may be necessary to cover all of these needs, and the diet also benefits from immune system boosters like multivitamins. 

Aside from preparing the body, the mind of the patient can also be readied for surgery. Many patients feel anxious about an upcoming surgery. Managing this stress comes from channeling these feelings into productive, realistic thinking about the process of an operation and recovery. SPAR guides mental prehabilitation through the use of a gratitude journal, practicing mindfulness and meditation, sleeping and creating a reliable support system. Activities that bring joy to the patient, such as activity, hobbies and positive thinking can help elevate mood. When the mind and mental state of a patient are healthy, it can have a positive impact on their bodily health.

With these goals and incremental changes to lifestyle, patients can expect an improvement to their body and mind both before and after surgery.

Contact WashU About the SPAR Program

For general requests or to refer a patient to the SPAR program, please fill out one of the forms below and a member of our SPAR team will be in contact soon.

Patients can request information about SPAR through this digital form. Physician referrals should be directed through a Patient Referral Form.