Key result
The SPAR prehabilitation program significantly decreased 30-day mortality (0% vs 4.1%, p=0.036) and non-home discharge (6.5% vs 15.9%, p=0.014) compared to matched historical controls.
Why the study?
The preoperative period is a key target to improve postoperative outcomes in older patients with comorbidities, but the impact of a multidisciplinary prehabilitation program remained to be determined.
Does a preoperative multidisciplinary prehabilitation program reduce postoperative 30-day mortality and the need for non-home discharge in high-risk surgical patients?
Cohort (n=472)
No
Does a preoperative multidisciplinary prehabilitation program reduce postoperative 30-day mortality and the need for non-home discharge in high-risk surgical patients?
Absolute Event Rate: 0% vs 4.1%
p-value: p=0.036
A preoperative multidisciplinary prehabilitation program may safely reduce 30-day mortality and the need for non-home discharge in high-risk surgical patients.
May reduce 30-day mortality and non-home discharge in high-risk patients; leaves open confirmation via prospective RCTs.
BACKGROUND: The preoperative period is an important target for interventions (eg Surgical Prehabilitation and Readiness [SPAR]) that can improve postoperative outcomes for older patients with comorbidities. STUDY DESIGN: To determine whether a preoperative multidisciplinary prehabilitation program (SPAR) reduces postoperative 30-day mortality and the need for non-home discharge in high-risk surgical patients, surgical patients enrolled in a prehabilitation program targeting physical activity, pulmonary function, nutrition, and mindfulness were compared with historical control patients from 1 institution's American College of Surgeons (ACS) NSQIP database. SPAR patients were propensity score-matched 1:3 to pre-SPAR NSQIP patients, and their outcomes were compared. The ACS NSQIP Surgical Risk Calculator was used to compare observed-to-expected ratios for postoperative outcomes. RESULTS: A total of 246 patients were enrolled in SPAR. A 6-month compliance audit revealed that overall patient adherence to the SPAR program was 89%. At the time of analysis, 118 SPAR patients underwent surgery with 30 days of follow-up. Compared with pre-SPAR NSQIP patients (n = 4,028), SPAR patients were significantly older with worse functional status and more comorbidities. Compared with propensity score-matched pre-SPAR NSQIP patients, SPAR patients had significantly decreased 30-day mortality (0% vs 4.1%, p = 0.036) and decreased need for discharge to postacute care facilities (6.5% vs 15.9%, p = 0.014). Similarly, SPAR patients exhibited decreased observed 30-day mortality (observed-to-expected ratio 0.41) and need for discharge to a facility (observed-to-expected ratio 0.56) compared with their expected outcomes using the ACS NSQIP Surgical Risk Calculator. CONCLUSIONS: The SPAR program is safe and feasible and may reduce postoperative mortality and the need for discharge to postacute care facilities in high-risk surgical patients.
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Rodríguez et al. (2023) conducted a cohort in High-risk surgical patients (n=472). Surgical Prehabilitation and Readiness (SPAR) program vs. Propensity score-matched historical controls was evaluated on 30-day mortality (p=0.036). The SPAR prehabilitation program significantly decreased 30-day mortality (0% vs 4.1%, p=0.036) and non-home discharge (6.5% vs 15.9%, p=0.014) compared to matched historical controls.
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