Speakers
Dr. Angus CHU
Consultant
Department of Medicine & Geriatrics
Tuen Mun Hospital
Hong Kong
Angus graduated from the medical school of the Hong Kong University in 1994. He received his training in the Department of Rehabilitation in Kowloon Hospital and completed the training as Rehabilitation specialist in 2004. Angus had joined Tuen Mun Hospital since Jul 2004. He is now the deputy team head of the Rehabilitation team in the Department of Medicine and Geriatrics leading a service that serves patients with a wide spectrum of disabling conditions in the New Territory Wester Cluster.
From rehabilitating disabling conditions, Tuen Mun Hospital Rehabilitation team is pioneer in introducing prehabilitation for patients with high-risk medical illness e.g. severe chronic lung and chronic ischaemic heart disease preparing for major cancer surgery to prevent disabling complications. Angus is currently the Chairman convening a multidisciplinary working group in the development of Prehabilitation in the Hospital Authority.
With the advances in diagnostic, medical therapy, surgical and anaesthesiological care, curative or palliative surgery can be considered in older patients or those having more complicated background medical conditions whom may have been precluded from surgical consideration by patients himself or the clinical team in the past because of the anticipated high perioperative complication rate. Although the exact role of CPET in predicting outcome has yet to be determined by more robust study, it helps not only to objectively evaluate one’s cardiopulmonary reserves and thus fitness to combat the peri-operative stress but also to describe one’s impairment profile that provides a foundation for optimization possible through an integrated prehabilitation programme that involved medical optimization, physical training, nutritional intervention and health behavioural modification.
In our centre, we have pioneered a service model collaborated with the anaesthesiologists and surgeons. Patients planned for high risk non-cardiac surgery are co-evaluated by anaesthesiologists and prehabilitation physicians clinically and by CPET assessment. Patients with borderline performances with low VO2 Peak/ VO2 AT +/- high VE/VCO2 were recruited for a 2 - 4 weeks integrated prehabilitation training with pre-determined goal. Most patients are considered high-exercise risk because of the background comorbidity and required specialist-led training. Medical review and optimization are provided at the same time as needed. Surgery will be proceeded as planned once the goal is achieved within the operable time frame. For those performed less favourably, they are counselled preemptively along the prehabilitation “journey” in order to facilitate a final shared decision that is to the best interest of that patient.
