Actionable Factors Fostering Health Value Generation and Scalability of Prehabilitation: A Prospective Cohort Study.

IMPORTANCE

Prehabilitation has potential for improving surgical outcomes as shown in previous randomized controlled trials. However, a marked efficacy-effectiveness gap is limiting its scalability. Comprehensive analyses of deployment of the intervention in real-life scenarios are required.

OBJECTIVE

To assess health outcomes and cost of prehabilitation.

DESIGN

Prospective cohort study with a control group built using propensity score-matching techniques.

SETTING

Prehabilitation Unit in a tertiary-care university hospital.

PARTICIPANTS

Candidates for major digestive, cardiac, thoracic, gynecologic, or urologic surgeries.

INTERVENTION

Prehabilitation program, including supervised exercise training, promotion of physical activity, nutritional optimization, and psychological support.

MAIN OUTCOMES AND MEASURES

The comprehensive complication index, hospital and intensive care unit length of stay, and hospital costs per patient until 30 days after surgery. Patients were classified by the degree of program completion and level of surgical aggression for sensitivity analysis.

RESULTS

The analysis of the entire study group did not show differences in study outcomes between prehabilitation and control groups (n=328 each). The per-protocol analysis, including only patients completing the 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 reduction in mean intensive care unit stay [2.3 (2.7) vs 3.8 (4.2) days; P =0.021] and generated mean cost savings per patient of €3092 (32% cost reduction) ( P =0.007). Five priority areas for action to enhance service efficiencies were identified.

CONCLUSIONS AND RELEVANCE

The study indicates a low rate of completion of the intervention and identifies priority areas for re-design of service delivery to enhance the effectiveness of prehabilitation.