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Pre-operative Risk Education Package


Major Surgery, Prehabilitation & Behavioural Change

Buck, D. and Frosini, F. (2012) Clustering of unhealthy behaviours over time: Implications for policy and practice. Available at (Accessed 1 February 2015).

Durrand, J. et al. (2016) 'Prehabilitation.', in Stuart-Smith, K. (ed.) Perioperative medicine: Current controversies. London: Springer-Verlag, pp. 15-47.

Durrand, J.W., Batterham, A.M. and Danjoux, G.R. (2014) 'Pre-habilitation. I: Aggregation of marginal gains', Anaesthesia, 69(5), pp. 403-406.

International Surgical Outcomes Study Group (2016) 'Global patient outcomes after elective surgery: Prospective cohort study in 27 low-, middle- and high-income countries', British Journal of Anaesthesia, 117(5), pp. 601-609.

Moonesinghe, S.R. et al. (2014) 'Survival after postoperative morbidity: A longitudinal observational cohort study', British Journal of Anaesthesia, 113(6), pp. 977-984.

National Institute for Health and Care Excellence (2007) Behaviour change: the principles for effective interventions. Available at: (Accessed 1 February 2015).

Pearse, R.M. et al. (2012) 'Mortality after surgery in Europe: A 7 day cohort study', The Lancet, (9847), pp. 1059-1065.

Rubak, S. et al. (2005) 'Motivational interviewing: A systematic review and meta-analysis', British Journal of General Practice, 55(513), pp. 305-312.

Warner, D.O. (2009) 'Surgery as a teachable moment: Lost opportunities to improve public health', Archives of Surgery, 144(12), pp. 1106-1107.

Wilson, K. et al. (2015) 'When it comes to lifestyle recommendations, more is sometimes less: A meta-analysis of theoretical assumptions underlying the effectiveness of interventions promoting multiple behavior domain change', Psychological Bulletin, 141(2), pp. 474-509.


Office for National Statistics (2013) General lifestyle survey 2011. Available at: (Accessed: 1 April 2015).

Oppedal, K. et al. Preoperative alcohol cessation prior to elective surgery. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub2.

Tønnesen, H. et al. (2009) 'Smoking and alcohol intervention before surgery: Evidence for best practice', British Journal of Anaesthesia, 102(3), pp. 297-306.

Tønnesen, H. (2003) 'Alcohol abuse and postoperative morbidity', Danish Medical Bulletin, 50(2), pp. 139-160.


Myers, K. et al. (2011) 'Stopping smoking shortly before surgery and postoperative complications: A systematic review and meta-analysis', Archives of Internal Medicine, 171(11), pp. 983-989.

Theadom, A. and Cropley, M. (2006) 'Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: A systematic review', Tobacco Control, 15(5), pp. 352-358.

Thomsen, T., Villebro, N. and Møller, A.M. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4.

Turan, A. et al. (2011) 'Smoking and perioperative outcomes', Anesthesiology, 114(4), pp. 837-846.

Wong, J. et al. (2012) 'Short-term preoperative smoking cessation and postoperative complications: A systematic review and meta-analysis', Canadian Journal of Anaesthesia, 59(3), pp. 268-279.

Physical Activity

Academy of Medical Royal Colleges (2015) Exercise: the miracle cure and the role of the doctor in promoting it. Available at: (Accessed 1 February 2015).

Burke, S.M. et al. (2006) 'Group versus individual approach? A meta-analysis of the effectiveness of interventions to promote physical activity', Sport and Exercise Psychology Review, 2(1), pp. 19-35.

Department for Culture, Media and Sport (2012) Taking Part 2011/12 quarter 4: Statistical Release Quarter 4. Available at: (Accessed 1 February 2015).

Health Survey Trends (2008) Health survey for England. Available: (Accessed 1 February 2015).

Jack, S. (2013) The Effects of a 9 -Week exercise programme on fitness and quality of life in rectal cancer patients after chemoradiotherapy and before surgery (SRETP). Available at: (Accessed: 1 February 2015).

National Institute for Health and Care Excellence (2013) Physical activity: brief advice for adults in primary care. Available at: (Accessed 1 February 2015).

O'Doherty, A.F. et al. (2013) 'Preoperative aerobic exercise training in elective intra-cavity surgery: A systematic review', British Journal of Anaesthesia, 110(5), pp. 679-689.

Scottish Government (2014) Health of Scotland’s population – physical activity. Available at: (Accessed 1 February 2015).

Sisson, S.B. et al. (2009) 'Volume of exercise and fitness non-response in sedentary, post-menopausal women', Medicine and Science in Sports and Exercise, 41(3), pp. 539–545.

Snowden, C.P. et al. (2013) 'Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people', Annals of Surgery, 257(6), pp. 999-1004.

Tew, G.A. et al. (2014) 'High-intensity interval exercise training before abdominal aortic aneurysm repair (HIT-AAA): Protocol for a randomised controlled feasibility trial', BMJ Open, 4(1), pp. e004094-e004094. doi:10.1136/bmjopen-2013-004094.

Thompson, P.D. et al. (2007) 'Exercise and acute cardiovascular events placing the risks into perspective: A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology', Circulation, 115(17), pp. 2358-2368.

Valkenet, K. et al. (2011) 'The effects of preoperative exercise therapy on postoperative outcome: A systematic review', Clinical Rehabilitation, 25(2), pp. 99-111.

West, M.A. et al. (2015) 'Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: A blinded interventional pilot study', British Journal of Anaesthesia, 114(2), pp. 244-251.

World Health Organization (2010) Global recommendations on physical activity for health. Available at: (Accessed 1 February 2015).


Baron, D.M. et al. (2014) 'Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients', British Journal of Anaesthesia, 113(3), pp. 416-423.

Clevenger, B. and Richards, T. (2015) 'Pre-operative anaemia', Anaesthesia, 70, pp. 20-e8.

Hans, G. and Jones, N. (2013) 'Preoperative anaemia', Continuing Education in Anaesthesia, Critical Care & Pain, 13(3), pp. 71-74.

Isbister, J.P. (2013) 'The three-pillar matrix of patient blood management--an overview', Best Practice & Research. Clinical Anaesthesiology, 27(1), pp. 69-84.

Musallam, K.M. et al. (2011) 'Preoperative anaemia and postoperative outcomes in non-cardiac surgery: A retrospective cohort study', The Lancet, 378(9800), pp. 1396-1407.

National Blood Authority (Australia) (2012) Patient blood management guidelines: module 2 – perioperative. Available at: (Accessed 1 March 2015).

Spahn, D.R. (2010) 'Anemia and patient blood management in hip and knee surgery: A systematic review of the literature', Anesthesiology, 113(2), pp. 482-495.


Clegg, A. et al. (2013) 'Frailty in elderly people', The Lancet, 381(9868), pp. 752-762.

Fried, L.P. et al. (2001) 'Frailty in older adults: Evidence for a phenotype', The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(3), pp. M146-M156.

Harari, D. et al. (2007) 'Proactive care of older people undergoing surgery ('POPS'): Designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients', Age and Ageing, 36(2), pp. 190-196.

Hewitt, J. et al. (2015) 'Prevalence of frailty and its association with mortality in general surgery', American Journal of Surgery, 209(2), pp. 254-259.

Hubbard, R.E. and Story, D.A. (2014) 'Patient frailty: The elephant in the operating room', Anaesthesia, 69 Suppl 1, pp. 26-34.

Li, H., Manwani, B. and Leng, S.X. (2011) 'Frailty, inflammation, and immunity', Aging and Disease, 2(6), pp. 466-473.

Partridge, J.S.L. et al. (2014) 'The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: A systematic review', Anaesthesia, 69 Suppl 1, pp. 8-16.

Partridge, J.S.L., Harari, D. and Dhesi, J.K. (2012) 'Frailty in the older surgical patient: A review', Age and Ageing, 41(2), pp. 142-147.

Rockwood, K. et al. (2004) 'Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: Report from the Canadian Study of Health and Aging', The Journals of Gerontology: Series A: Biological Sciences and Medical Sciences, 59(12), pp. 1310-1317.

Rolfson, D.B. et al. (2006) 'Validity and reliability of the edmonton frail scale', Age and Ageing, 35(5), pp. 526-529.

Cognitive Impairment

Boyle, P.A. et al. (2010) 'Physical frailty is associated with incident mild cognitive impairment in community-based older persons', Journal of the American Geriatrics Society, 58(2), pp. 248-255.

Buchman, A.S. et al. (2007) 'Frailty is associated with incident alzheimer's disease and cognitive decline in the elderly', Psychosomatic medicine, 69(5), pp. 483-489.

Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) '"Mini-mental state". A practical method for grading the cognitive state of patients for the clinician', Journal of Psychiatric Research, 12(3), pp. 189-198.

Kiely, D.K. et al. (2009) 'Persistent delirium predicts greater mortality', Journal of the American Geriatrics Society, 57(1), pp. 55-61.

Long, L.S., Shapiro, W.A. and Leung, J.M. (2012) 'A brief review of practical preoperative cognitive screening tools', Canadian Journal of Anaesthesia, 59(8), pp. 798-804.

Mashour, G.A., Woodrum, D.T. and Avidan, M.S. (2015) 'Neurological complications of surgery and anaesthesia', British Journal of Anaesthesia, 114(2), pp. 194-203.

Nadelson, M.R., Sanders, R.D. and Avidan, M.S. (2014) 'Perioperative cognitive trajectory in adults', British Journal of Anaesthesia, 112(3), pp. 440-451.

Neufeld, K.J. (2013) 'Outcomes of early delirium diagnosis after general anesthesia in the elderly', Anesthesia and Analgesia, 117(2), pp. 471-478.

Partridge, J.S.L. et al. (2014) 'The prevalence and impact of undiagnosed cognitive impairment in older vascular surgical patients', Journal of Vascular Surgery, 60(4), pp. 1002-11.

Song, X., Mitnitski, A. and Rockwood, K. (2011) 'Nontraditional risk factors combine to predict Alzheimer disease and dementia', Neurology, 77(3), pp. 227-234.


Evans, D.C. et al. (2014) 'Nutrition optimization prior to surgery', Nutrition in Clinical Practice, 29(1), pp. 10-21.

Grass, F et al. (2011) 'Perioperative nutrition is still a surgical orphan: Results of a Swiss-Austrian Survey', European Journal of Clinical Nutrition, 65(5), pp. 642-647.

Kondrup, J, et al. (2003) 'Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical traials', Clinical Nutrition, 22(3), pp. 321-336.

Martindale, R.G. et al. (2013) 'Perioperative nutrition: What is the current landscape?', JPEN: Journal of Parenteral and Enteral Nutrition, 37(5), pp. 5S-20S.

Schiesser, M. et al. (2009) 'The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery', Surgery, 145(5), pp. 519-526.

Studley, H.O. (2001) 'Percentage of weight loss: A basic indicator of surgical risk in patients with chronic peptic ulcer. 1936', Nutricion Hospitalaria, 16(4), pp. 141-143.