ArticleSurgery2025
The benefits of a department-wide prehabilitation program: A propensity score match analysis.
Article in Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDespite increasing use of prehabilitation in aging surgical patients, large studies demonstrating benefits on postoperative outcomes are lacking. This study aimed to determine if a department-wide prehabilitation program (Surgical Prehabilitation and Readiness) improves 30-day mortality, discharge to post-acute care facilities, and postoperative length of stay in high-risk surgical patients compared to historical controls, and to examine age's influence on these outcomes.
methodsSurgical Prehabilitation and Readiness patients with 30 days of postoperative follow-up were compared to patients from the National Surgical Quality Improvement Program database undergoing procedures at the same institution during the 5 years before Surgical Prehabilitation and Readiness implementation (pre-Surgical Prehabilitation and Readiness). Surgical Prehabilitation and Readiness patients were propensity score matched to pre-Surgical Prehabilitation and Readiness patients in a 1:3 ratio, and outcomes were compared.
resultsOver 40 months, 424 patients completed Surgical Prehabilitation and Readiness and underwent surgery with 30 days of follow-up. Compared with pre-Surgical Prehabilitation and Readiness patients, Surgical Prehabilitation and Readiness patients were significantly older (median: 69.9 vs 60.7 years, P < .001) with higher American Society of Anesthesiologists class (≥3: 84.7% vs 54.4%, P < .001) and more comorbidities. Compared to propensity score-matched pre-Surgical Prehabilitation and Readiness patients (n = 1,161), Surgical Prehabilitation and Readiness patients (n = 387) had significantly decreased 30-day mortality (0.8% vs 2.8%, P = .023), discharge to post-acute care facility (8.8% vs 12.9%, P = .030), and length of stay (7.2 vs 8.0 days, P = .039). Older Surgical Prehabilitation and Readiness patients (age > median) exhibited significantly decreased 30-day mortality (0.6% vs 3.3%, P = .044) and discharge to post-acute care facility (11.6% vs 19.3%, P = .017), whereas younger Surgical Prehabilitation and Readiness patients (age ≤ median) exhibited decreased length of stay (6.9 vs 8.2 days, P = .021).
conclusionsPrehabilitation reduces postoperative mortality, loss of functional independence, and hospital recovery time, and the benefits vary by age. These findings support the implementation of prehabilitation programs in clinical practice.
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