In a new study, researchers found that older adults who “train” for a major operation by exercising, eating a healthy diet, and practicing stress reduction techniques have shorter hospital stays.
They are more likely to return to their own homes afterward rather than another facility compared with similar patients who do not participate in preoperative rehabilitation
The research was conducted by a team at the University of Michigan, Ann Arbor.
The team evaluated a home-based program of preoperative rehabilitation—called prehabilitation—for Michigan Medicare beneficiaries.
Involving physical and lifestyle changes, prehabilitation, or “prehab,” optimizes a patient’s well-being and ability to withstand the stress of undergoing an operation.
Previous studies have shown that prehabilitation lowers the rate of postoperative complications and speeds the patient’s return to their normal functioning, among other advantages.
In the study, the researchers tested the real-world effectiveness and cost savings of prehabilitation.
Patients underwent diverse cardiothoracic (chest/heart) and abdominal operations at 21 hospitals in Michigan.
They participated in a statewide prehabilitation program called the Michigan Surgical & Health Optimization Program (MSHOP).
MSHOP involved a home-based walking program in which surgical patients tracked their steps using a pedometer and received daily reminders and feedback through phone, email, or text messages.
Program participants received educational materials on nutrition, relaxation techniques, and smoking cessation as well.
They also practiced using an incentive spirometer, a medical device that helps patients keep their lungs healthy after an operation.
Included in the study were 523 Medicare patients who participated in MSHOP for at least one week before a major operation.
Of the participants, 62% were reportedly “engaged” in the prehabilitation program, defined as recording step counts three or more times per week for most of the program.
The team found prehabilitation was strongly linked to improved health outcomes that are important to patients or insurers:
The hospital length of stay was shorter by one day, with a median of 6 days for patients versus 7 days for controls, who received no prehabilitation.
Program participants were more likely to be discharged from the hospital to home: 65.6% versus 57% of controls.
Medicare paid nearly $3,200 less in total payments for both hospital and posthospital care for patients who underwent prehabilitation than for controls: $31,641 versus $34,837.
Insurance payments were especially lower among patients for posthospital care, including skilled nursing facility ($941 versus $1,566 for controls) and home health care ($829 versus $960 for controls).
The team says every patient scheduled for a major operation—not just those at high risk—should ask their surgeon for a prehabilitation program.
One author of the study is Michael J. Englesbe, MD, FACS, a liver transplant surgeon.
The study is published in Journal of the American College of Surgeons.
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