• Ilona M Punt, Roel van der Most, Bart C Bongers, Anouk Didden, Hulzebos Erik H J EHJ University Children's Hospital and Medical Centre Utrecht, Child and Development and Exercise Centre, University Medical Centre Utrecht, Utrecht, Ni, Jaap J Dronkers, and van Meeteren Nico L U NLU Institut für Epidemiologie, Maastricht University, CAPHRI, Postfach 616, 6200 MD, Maastricht, Niederlande. .
• Institut für Epidemiologie, Maastricht University, CAPHRI, Postfach 616, 6200 MD, Maastricht, Niederlande. ilona.punt@maastrichtuniversity.nl.
• Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2017 Apr 1; 60 (4): 410-418.

AbstractSurgery is aimed at improving a patient's health. However, surgery is plagued with a risk of negative consequences, such as perioperative complications and prolonged hospitalization. Also, achieving preoperative levels of physical functionality may be delayed. Above all, the "waiting" period before the operation and the period of hospitalisation endanger the state of health, especially in frail patients.The Better in Better out™ (BiBo™) strategy is aimed at reducing the risk of a complicated postoperative course through the optimisation and professionalisation of perioperative treatment strategies in a physiotherapy activating context. BiBo™ includes four steps towards optimising personalised health care in patients scheduled for elective surgery: 1) preoperative risk assessment, 2) preoperative patient education, 3) preoperative exercise therapy for high-risk patients (prehabilitation) and 4) postoperative mobilisation and functional exercise therapy.Preoperative screening is aimed at identifying frail, high-risk patients at an early stage, and advising these high-risk patients to participate in outpatient exercise training (prehabilitation) as soon as possible. By improving preoperative physical fitness, a patient is able to better withstand the impact of major surgery and this will lead to both a reduced risk of negative side effects and better short-term outcomes as a result. Besides prehabilitation, treatment culture and infrastructure should be inherently changing in such a way that patients stay as active as they can, socially, mentally and physically after discharge.

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