Taking Control of Your Surgery: Impact of a Prehabilitation Program on Major Abdominal Surgery

Abstract

Background:

Surgery is a major physiologic stress comparable to intense exercise. Diminished cardiopulmonary reserve is a major predictor of poor outcomes. Current preoperative workup focuses mainly on identifying risk factors, however little attention is devoted to improving cardiopulmonary reserve beyond counseling. We propose that patients could be optimized for a “surgical marathon” similar to the preparation of an athlete.

Study Design:

The Michigan Surgical and Health Optimization Program (MSHOP) is a formal prehabilitation program that engages patients in four activities before surgery: physical activity, pulmonary rehabilitation, nutritional optimization, and stress reduction. We prospectively collected demographic, intraoperative (first hour), and postoperative data for patients enrolled in MSHOP undergoing major abdominal surgery. Statistical analysis was performed using 2:1 propensity score matching to compare the MSHOP group (N=40) to emergency (N=40) and elective, non-MSHOP (N=76) patients.

Results:

Overall, 70% of MSHOP patients complied with the program. Age, gender, ASA classification, and BMI did not differ significantly between groups. One hour intraoperatively, MSHOP patients showed improved systolic and diastolic blood pressures and lower heart rate (Figure). There was a significant reduction in Clavien-Dindo class 3–4 complications in the MSHOP group (30%) compared to the non-prehabilitation (38%) and emergency (48%) groups (p=0.05). This translated to total hospital charges averaging $75,494 for the MSHOP group, $97,440 for the non-prehabilitation group, and $166,085 for the emergency group (p < 0.001).

Conclusion:

Patients undergoing prehabilitation prior to colectomy showed positive physiologic effects and experienced fewer complications. The average savings of $21,946 per patient represents a significant cost offset for a prehabilitation program, and should be considered for all patients undergoing surgery.

Precis

For frail patients undergoing major abdominal surgery, participation in a formal prehabilitation program improves their physiologic response to surgery, reduces postoperative complications, and prevents significant increases in cost compared to non-frail patients who do not participate in prehabilitation.