Prehabilitation Can Generate Cost Savings and Improve Surgical Outcomes
A woman completing a prehabilitation exercise
By Javan Leong
July 26, 2023
Key Takeaways:
• Prehabilitation is the process of preparing patients for surgery through targeted physical activity, psychological well-being, and nutritional guidance.

When prehabilitation is integrated into existing surgical care plans...
• Patient outcomes may improve, including functional capacity, decreased length of stay, and bolstered post-op recovery rate.
• Medical providers may generate cost savings by minimizing both additional medical interventions and reducing resource utilization.
• Patient experience may improve with individualized, high-quality care.

In today’s healthcare landscape, the need for cost-saving measures is more critical than ever.
With understaffed facilities and overfilled hospital beds, healthcare providers need innovative strategies to enhance patient outcomes while minimizing expenses. This need is even more significant in the geriatric population, whose age significantly impairs their response to medical treatment. One strategy gaining recognition is prehabilitation, a proactive approach that optimizes patients’ health before surgery or medical interventions.

The Role of Prehabilitation in Surgical Outcomes
Prehabilitation programs can play a vital role in improving surgical outcomes by addressing patients’ overall health and well-being before surgery. These multimodal programs focus on enhancing patients’ physical fitness, emphasizing proper nutrition, and providing psychological support to prepare patients’ bodies for surgery.

To quantify the benefits of prehabilitation, we can look to postoperative functional capacity. Functional capacity is defined as the ability to perform and cope with real-world, daily activities which stem from a unified effort from the cardiovascular, pulmonary, and skeletal muscular systems.1 It also encompasses an interdependent relationship with mental well-being.2,3 In three randomized controlled tests (RCTs), 130 out of 250 participants with non‐metastatic colorectal cancer underwent a four-week prehabilitation program. This prehabilitation group demonstrated improvement in the 6-minute walk test, suggesting improvement in functional capacity.4 In addition, multimodal prehabilitation programs with exercise point to positive outcomes. One study performed a meta-analysis of 8 RCTs (randomized controlled trials) among 422 major abdominal surgical patients, and results showed a significant reduction in postoperative pulmonary complications as well as in postoperative overall morbidity in the prehabilitation group compared to standard care.5

Furthermore, prehabilitation programs have been associated with reduced surgical site infections, lower rates of readmission6, and enhanced postoperative recovery.7 In a study conducted in Montreal, patients who received multimodal prehabilitation before colorectal cancer resection surgery had an 80% recovery rate by 8 weeks after surgery, compared to a historical control group who had only received postoperative rehabilitation, which had a 40% recovery rate.6

Though there’s still room for further research, current studies8 advocate that multimodal prehabilitation helps prepare patients both physically and mentally for surgery, improving quality of life post-operation.

Cost savings with surgical prehabilitation
Extended hospital stays impose a significant financial burden on patients, healthcare providers, and the overall healthcare system. By implementing prehabilitation programs, hospitals can prepare patients for faster recovery and discharge, reducing the length of hospital stays and associated costs.

Studies examining the impact of prehabilitation on hospital stays have shown positive results.9 Patients who participate in prehabilitation programs can experience shorter hospital stays, leading to substantial cost savings. In a retrospective review of 1,043 patients who underwent total knee arthroplasty, prehabilitation patients had shorter hospital stays (37.1% leaving inpatient care on postoperative day 1) and improved discharge disposition.10 In terms of savings, a study which looked at patients who underwent major abdominal surgery calculated that there was an average of $21,946 saved per patient.8

The reduced postoperative complications11 and shorter hospital stays resulting from prehabilitation translate into significant cost savings for healthcare providers. Fewer complications mean reduced medical interventions, decreased medication costs, and lower readmission rates. Additionally, shorter hospital stays reduce resource utilization, including bed occupancy, staffing requirements, and associated overhead costs.

Continuity of care in an overburdened system
The foundation of healthcare has always been continuity of care for patients. This practice has resulted in better healthcare outcomes, higher satisfaction rates, and cost-effective healthcare. 12 However, current healthcare systems are strained with case overload, making it increasingly challenging to provide the level of care patients deserve.

Prehabilitation programs offer a promising solution to the challenges faced by current healthcare systems. By incorporating individualized care plans tailored to each patient’s needs, prehabilitation assists healthcare providers in delivering a level of attention that patients deserve, alleviating the burden on medical staff. This proactive approach also helps identify potential health risks and prepares patients physically and mentally before undergoing medical interventions or procedures.

Furthermore, prehabilitation programs have been shown to increase patient satisfaction significantly. Prehabilitation fosters a sense of ownership and engagement by actively involving patients in their care journey and empowering them to take charge of their health. Patients appreciate the personalized attention and support provided by healthcare professionals during prehabilitation, which enhances their overall healthcare experience.

At Ooney, we focus on addressing the unique needs of elderly surgical patients whose age directly impacts health care delivery and perianesthesia nursing. Due to this, we believe it is essential to focus on the preparation of the elderly patient in aspects of preoperative assessment and instruction, nutrition, pain management, and promotion of sleep and comfort.13 Through Ooney’s tailored user interface and care programs, geriatric patients can receive continued care in the days leading up to their surgery and be more appropriately prepared for their surgery, promoting positive outcomes.

Prehabilitation serves as a multifaceted solution
Overall, patients’ quality of life and satisfaction can improve with the integration of prehabilitation into existing care programs. Prehabilitation can be a powerful strategy to generate substantial cost savings with minimal upfront costs. At Ooney, we have optimized the content and user experience for older adults so both patients and healthcare providers can enjoy the benefits of effective prehabilitation.

Healthcare leaders have an opportunity to recognize the potential of prehabilitation and invest in its implementation. The American College of Surgeons even concluded in a study that a prehabilitation program “should be considered for all patients undergoing surgery” 12, emphasizing its importance for improving patient outcomes and generating significant cost savings. By embracing prehabilitation, we can strengthen our healthcare system, enhance patient care, and achieve a brighter future.

1. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, Collins E, Fletcher G; American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Nursing. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007 Jul 17;116(3):329-43. doi: 10.1161/CIRCULATIONAHA.106.184461. Epub 2007 Jun 18. PMID: 17576872.

2. Gill Windle, Dyfrig Hughes, Pat Linck, Ian Russell & Bob Woods (2010) Is exercise effective in promoting mental well-being in older age? A systematic review, Aging & Mental Health, 14:6, 652-669, DOI: 10.1080/13607861003713232

3. Åberg, A.C., Sidenvall, B., Hepworth, M. et al. On loss of activity and independence, adaptation improves life satisfaction in old age – a qualitative study of patients’ perceptions. Qual Life Res 14, 1111–1125 (2005).

4. Molenaar CJL, van Rooijen SJ, Fokkenrood HJP, Roumen RMH, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database of Systematic Reviews 2023, Issue 5. Art. No.: CD013259. DOI: 10.1002/14651858.CD013259.pub3. Accessed 02 August 2023.

5. Heger, P., Probst, P., Wiskemann, J. et al. A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg 24, 1375–1385 (2020).

6. Barberan-Garcia, Anael & Ubré, Marta & Pascual-Argente, Natàlia & Risco, Raquel & Faner, J. & Balust, Jaume & Lacy, A.M. & Puig-Junoy, Jaume & Roca, Josep & Martinez-Palli, Graciela. (2019). Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. British Journal of Anaesthesia. 123. 10.1016/j.bja.2019.05.032.

7. Steffens D, Young J, Beckenkamp PR, Ratcliffe J, Rubie F, Ansari N, Pillinger N, Koh C, Munoz PA, Solomon M. Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial. Pilot Feasibility Stud. 2021 Jan 13;7(1):27. doi: 10.1186/s40814-021-00765-8. PMID: 33441181; PMCID: PMC7805142.

8. Howard R, Yin YS, McCandless L, Wang S, Englesbe M, Machado-Aranda D. Taking Control of Your Surgery: Impact of a Prehabilitation Program on Major Abdominal Surgery. J Am Coll Surg. 2019 Jan;228(1):72-80. doi: 10.1016/j.jamcollsurg.2018.09.018. Epub 2018 Oct 22. PMID: 30359831; PMCID: PMC6309718.

9. Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil. 2011 Feb;25(2):99-111. doi: 10.1177/0269215510380830. Epub 2010 Nov 8. PMID: 21059667.

10. Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil. 2011 Feb;25(2):99-111. doi: 10.1177/0269215510380830. Epub 2010 Nov 8. PMID: 21059667.

11. Barberan-Garcia A, Ubré M, Roca J, Lacy AM, Burgos F, Risco R, Momblán D, Balust J, Blanco I, Martínez-Pallí G. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg. 2018 Jan;267(1):50-56. doi: 10.1097/SLA.0000000000002293. PMID: 28489682.

12. Haggerty JL, Reid RJ, Freeman GK, et al. Continuity of care: a multidisciplinary review. BMJ. 2003;327(7425):1219–1221.

13. Asher ME. Surgical considerations in the elderly. J Perianesth Nurs. 2004 Dec;19(6):406-14. doi: 10.1016/j.jopan.2004.08.003. PMID: 15801350.