Actionable factors fostering scalability of prehabilitation

Abstract

Background: Prehabilitation shows efficacy to improve surgical outcomes, but scalability is limited by a marked efficacy-effectiveness gap. The intervention is a ‘teachable moment’ to encourage patients, particularly with chronic conditions, for positive lifestyles changes reducing disease burden.

Objective: To assess health outcomes and cost of prehabilitation.

Methods: Prospective cohort study in a real-life setting, with a control group built using propensity score matching, in candidates for major surgical procedures.

Outcomes: comprehensive complication index, hospital and intensive care unit (ICU) stays and hospital costs per patient. Patients were classified by the degree of program completion and level of surgical aggression for sensitivity analysis.

Results: In the intention-to-treat analysis, no differences were found between study arms (n=328 each). The per-protocol analysis, including only patients completing the prehabilitation program (n=112, 34%), showed a reduction in mean hospital stay (9.9 (7.2) vs. 12.8 (12.4) days; p=0.035). Completers undergoing highly aggressive surgeries (n=60) additionally showed a reduction in ICU stay (2.3 (2.7) vs. 3.8 (4.2) days; p=0.021) and generated mean cost savings per patient of 3,092€ (32% cost reduction) (p=0.007). Five priority areas for action to enhance effectiveness of prehabilitation were identified.

Conclusions: The study indicates low rate of completion and identifies priority areas for re-design of service delivery to enhance effectiveness of prehabilitation. Lessons learnt can be generalized to rehabilitation of chronic patients.

Funding: ISCIII "FIS-Smart PITeS project (PI18/00841)", co-funded by FEDER/FSE “Una manera de hacer Europa”.