Older adults who 'train' for a major operation spend less time in the hospital

Older adults who "train" for a major operation by exercising, eating a healthy diet, and practicing stress reduction techniques preoperatively have shorter hospital stays and 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, according to research findings. The new study, which appears as an "article in press" on the Journal of the American College of Surgeons website in advance of print, evaluated a home-based program of preoperative rehabilitation—called prehabilitation—for Michigan Medicare beneficiaries.The researchers also reported an association between prehabilitation and lower total insurance payments for all phases of care.

"Prehabilitation is good for patients, providers, and payers," said study coauthor Michael J. Englesbe, MD, FACS, a liver transplant surgeon at the University of Michigan, Ann Arbor. "We believe every patient should train for a major operation. It's like running a 5K race: You have to prepare."

Involving physical and lifestyle changes, prehabilitation, or "prehab," optimizes a patient's well-being and ability to withstand the stress of undergoing an operation, Dr. Englesbe said. Past studies show that prehabilitation lowers the rate of postoperative complications and speeds the patient's return to their normal functioning, among other advantages.

"Prehab has been gaining momentum over the past 10 years. More surgeons and other clinicians are appreciating its benefits," Dr. Englesbe said. "However, the feasibility and value of broad implementation of prehabilitation outside the research environment were unknown."

For this new study 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 that participated in a statewide prehabilitation program called the Michigan Surgical & Health Optimization Program (MSHOP). Patients' surgeons referred them to MSHOP if they were at high risk of postoperative complications, Dr. Englesbe, program co-developer and director, said.