Update: For Patients Who Need Surgery, Prehab Pays

An inexpensive program to help surgery patients get physically and mentally ready for their upcoming operations may help reduce overall costs and get them home faster, according to research from the University of Michigan (U-M).

Prehabilitation, as it’s called, uses the weeks before surgery to encourage patients to move more, eat healthier, cut back on tobacco, breathe deeper, reduce their stress, and focus on their goals for after their operation.

In 2017, after its first test in surgery patients at U-M, the approach showed signs of reducing total medical costs related to patients’ care and cutting their length of stay in the hospital, compared with similar patients who had surgery before the program began.

The new study, published in the Journal of the American College of Surgeons, confirms those results on a more rigorous scale.

It finds that prehab patients across the state left the hospital one day earlier and were more likely to go straight home rather than to a skilled nursing facility, compared with similar patients treated at the same hospital. Total costs for all care up to three months after surgery were nearly $3,200 less on average for those who went through prehab.

“Every time the prehab study has been studied, it’s found to increase the value of surgical care by improving care while reducing cost. This study cements the business case for hospitals to support it,” said Michael Englesbe, MD, who leads the U-M Department of Surgery team that published both studies.

“We also now recognize that prehab’s physical training may work partly because it empowers the patient to engage in their own recovery,” added Englesbe. “Patient empowerment is the ‘secret sauce,’ and we hope to harness it even more.”

The new study focused on patients with the highest risk of complications after surgery because they had a combination of underlying health conditions beyond the problem that required surgery.

Once enrolled in the Michigan Surgical and Health Optimization Program, patients received a call or electronic message from a member of the team and materials about the importance of better nutrition, tobacco cessation, engaging in positive thinking and goal-setting, and reducing stress to their pre-surgery preparation.

They also received a pedometer to track their steps and an incentive spirometer to encourage them to practice taking deep breaths to improve their lung function before and after surgery.

In all, 62 percent of the participants tracked their walking three or more times per week, entering the numbers into their medical record or calling them in to a secure voicemail box. The program staff contacted patients who hadn’t logged steps to encourage them to do so.

In addition to the total cost and hospital length of stay differences, the patients in the program were less likely to need home healthcare after they went home, with 24 percent of the prehab patients receiving it compared with 29 percent of non-prehab patients. However, the prehab patients had about the same rates of nursing home stays, visits to emergency departments, and additional hospital stays after they left the hospital.

This article was adapted from information provided by Michigan Medicine – U-M.



IMAGE: FotoHelin/stock.adobe.com

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