Care coordinator-led prehabilitation for major surgery: An implementation science perspective

Abstract

Introduction: Prehabilitation, the process of preparing patients for surgical stressors, plays a pivotal role in improving postoperative recovery. At Sengkang General Hospital in Singapore, the SUrgical PREhabilitation for coMprehensive Enhanced recovery (SUPREME) programme utilises a multimodal approach to optimise patients’ health and comorbidities before major operations. This study evaluates SUPREME using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. Methods: A mixed-methods design was utilised. Qualitative data were gathered through semi-structured interviews with key stakeholders (doctors, patient coordinators, dietitians, physiotherapists, and caregivers). These were supplemented by quantitative audit data, including enrolment data and patient-reported health-related quality of life measured with the EuroQol 5-Dimension 5-Level (EQ-5D-5L) index. Results: Implementation demonstrated progressive departmental adoption, with 1082 patients enrolled between August 2022 and November 2025. Enrolment increased from 496 patients during the first 24 months to 586 over the subsequent 16 months. More than 900 patients completed surgery and were successfully discharged. Stakeholders reported strong belief in programme utility. Quantitative data showed significantly higher EQ-5D-5L scores at 3 months (mean difference +0.037, P=0.001) and 6 months (mean difference +0.036, P=0.006) compared with baseline. Dedicated patient coordinators played a key role in centralising scheduling and minimising logistical burden, supporting programme implementation. Conclusion: SUPREME demonstrated strong stakeholder support, progressive adoption, and favourable patient-reported health-related quality of life outcomes, supported by regular audits to guide workflow improvements. Future efforts should focus on personalising interventions and strengthening communication among stakeholders. SUPREME provides a scalable model for healthcare institutions seeking to integrate prehabilitation into routine surgical care.