The benefits of a department-wide prehabilitation program: A propensity score match analysis

Shaleen V Sathe; Yijin Huang; Jorge G Zarate Rodriguez; Heidy Cos; Jennifer Cook; Melanie Koenen; William C Chapman; Benjamin D Kozower; Ryan C Fields; Dominic E Sanford

doi:10.1016/j.surg.2025.109489

The benefits of a department-wide prehabilitation program: A propensity score match analysis

Surgery. 2025 Jun 12:184:109489. doi: 10.1016/j.surg.2025.109489. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO. Electronic address: s.sathe@wustl.edu.
² Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO.
³ Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
⁴ Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO.

PMID: 40513208
DOI: 10.1016/j.surg.2025.109489

Abstract

Background: Despite 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.

Methods: Surgical 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.

Results: Over 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).

Conclusions: Prehabilitation 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.