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Background: Health optimisation programmes are increasingly popular and aim to support patients to lose weight or stop smoking ahead of surgery, yet there is little published evidence about their impact. This study aimed to assess the feasibility of evaluating a programme introduced by a National Health Service (NHS) clinical commissioning group offering support to smokers/obese patients in an extra 3 months prior to the elective hip/knee surgery pathway.
Methods: Feasibility study mapping routinely collected data sources, availability and completeness for 502 patients referred to the hip/knee pathway in February–July 2018.
Results: Data collation across seven sources was complex. Data completeness for smoking and ethnicity was poor.
While 37% (184) of patients were eligible for health optimisation, only 28% of this comparatively deprived patient group accepted referral to the support offered. Patients who accepted referral to support and completed the programme had a larger median reduction in BMI than those who did not accept referral (− 1.8 BMI points vs. − 0.5). Forty-nine per cent of patients who accepted support were subsequently referred to surgery, compared to 61% who did not accept referral to support.
Conclusions: Use of routinely collected data to evaluate health optimisation programmes is feasible though demanding. Indications of the positive effects of health optimisation interventions from this study and existing literature suggest that the challenge of programme evaluation should be prioritised; longer-term evaluation of costs and outcomes is warranted to inform health optimisation policy development.
Original languageEnglish
Article number21
JournalPerioperative medicine
Issue number1
Publication statusPublished - 23 Jun 2022

Bibliographical note

Ethics approval and consent to participate
This study was approved by the North West/Liverpool East NHS Research
Ethics Committee (19/NW/0353). As data were routinely recorded and
anonymised before analysis, formal consent was not required from patients

This work was supported by the National Institute for Health Research
Applied Research Collaboration West (NIHR ARC West), with which several of
the authors are affiliated, JM is funded by a NIHR Academic Clinical
Fellowship, LO and RR’s time was funded by Bath and North East Somerset
Clinical Commissioning Group and Council, respectively.

Structured keywords

  • HEHP@Bristol
  • NIHR ARC West


  • Health optimisation
  • Prehabilitation
  • Obesity
  • Smoking
  • Elective surgery


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