Key result
Prehabilitation linked to ~6% lower odds of major postoperative complications, driven by fewer MIs.
Why the study?
Prehabilitation may improve physiological reserve before surgery, but large administrative and claims-based real-world evaluations across diverse procedure types remained limited.
Does prehabilitation reduce postoperative complications in adults undergoing major high-risk surgery?
Cohort (n=136,674)
Yes
Does prehabilitation reduce postoperative complications in adults undergoing major high-risk surgery?
Odds Ratio: 0.94 (95% CI 0.9–0.99)
Absolute Event Rate: 25.3% vs 26.9%
p-value: p=0.047
Claims-based prehabilitation prior to major surgery is associated with reduced perioperative myocardial infarction risk, especially in CABG patients, though it corresponds to higher total healthcare costs and varying results across other complication types.
May support prehabilitation evaluation in major surgery; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Prehabilitation, including preoperative exercise, nutrition optimization, behavioral support, and smoking cessation services, may improve physiological reserve in patients undergoing surgery; however, large administrative and claims-based real-world evaluations across diverse procedure types have remained limited. METHODS: This retrospective cohort study used IBM MarketScan claims (2010-2020) to identify adults undergoing coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, pneumonectomy, pancreatectomy, and colectomy. Prehabilitation was defined as claims for physical therapy, nutrition counseling, psychological/behavioral counseling, and smoking cessation services within 30-90 days preoperatively. Multivariable logistic regression assessed outcomes, including any major postoperative complication, readmission, and costs, adjusting for baseline patient and hospital factors. RESULTS: Among 136,674 patients, 6.6% (n = 9077) received prehabilitation. The median age was 56 (49-60), and 42.0% (n = 57,035) were female. Patients who received prehabilitation more commonly underwent pneumonectomy (15.8% vs. 11.3%) or AAA repair (4.7% vs. 3.2%) and received care at urban/metropolitan hospitals (86.9% vs. 84.7%) compared with individuals who did not undergo prehabilitation (all p < 0.001). Prehabilitation was associated with lower odds of any index complication (aOR 0.94, 95% CI 0.90-0.99) and lower risk of myocardial infarction (MI) at index hospitalization (aOR 0.78, 95% CI 0.71-0.85), 30 days (aOR 0.79, 95% CI 0.72-0.86), and 90 days (aOR 0.81, 95% CI 0.74-0.89). Moreover, patients who received prehabilitation experienced higher costs, both preoperatively (β 4227, 95% CI 3834-4621) and postoperatively (β 4020, 95% CI 2866-5173). In sub-analyses, the association between prehabilitation and lower odds of MI was maintained among CABG patients (aOR 0.83, 95% CI 0.76-0.90). CONCLUSIONS: Prehabilitation was associated with lower postoperative cardiac events but higher perioperative costs; the most favorable associations were observed among CABG patients, although these subgroup findings should be interpreted cautiously.
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Angez et al. (2026) conducted a cohort in Adults undergoing major surgery (CABG, AAA repair, pneumonectomy, pancreatectomy, or colectomy) (n=136,674). Prehabilitation vs. No prehabilitation was evaluated on Any major postoperative complication during index hospitalization (aOR 0.94, 95% CI 0.90-0.99, p=0.047). Prehabilitation was associated with lower odds of any index major complication compared to no prehabilitation (aOR 0.94, 95% CI 0.90-0.99), driven primarily by lower risk of myocardial infarction.
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